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General NPI Number Information
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NPI Number | 1821355603
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Entity Type | Individual
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Provider Name | KIMBERLY CHASE LCSW, LCSW-C
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Gender | Female
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Dates
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Enumeration Date | 04/18/2012
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Last Update Date | 01/24/2020
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Provider Practice Location Address
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Address Line | 6221 GREENLEIGH AVE UNIT 228
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City | MIDDLE RIVER
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State | MD
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Zip | 21220-2025
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Country | US
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Telephone | 732-535-0227
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Fax |
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Provider Business Mailing Address
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Address Line | 6221 GREENLEIGH AVE UNIT 228
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City | MIDDLE RIVER
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State | MD
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Zip | 21220-2025
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Country | US
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Telephone | 732-535-0227
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 44SL05770400
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | CSW006090
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 44SC05730600
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License Number State | NJ
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Taxonomy #4
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 23217
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License Number State | MD
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