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General NPI Number Information
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NPI Number | 1174988299
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Entity Type | Individual
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Provider Name | CHASTETY IVANIUK LCSW, LMSW, CASAC
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Gender | Female
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Dates
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Enumeration Date | 12/16/2015
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Last Update Date | 03/12/2025
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Provider Practice Location Address
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Address Line | 73 LENOX AVE
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City | NEW YORK
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State | NY
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Zip | 10026-3007
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Country | US
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Telephone | 212-663-1596
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Fax |
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Provider Business Mailing Address
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Address Line | 773 CENTRAL AVE
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City | WESTFIELD
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State | NJ
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Zip | 07090-2528
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Country | US
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Telephone | 917-601-7699
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 44SC06444100
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License Number State | NJ
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