=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548096878
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | GIA CHAWALA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/12/2024
-----------------------------------------------------
Last Update Date | 10/07/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3458 NEELY RD
-----------------------------------------------------
City | MC GUIRE AFB
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08641-5312
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 609-754-9324
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3458 NEELY RD
-----------------------------------------------------
City | MC GUIRE AFB
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08641-5312
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | 081008642
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------