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General NPI Number Information
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NPI Number | 1972301497
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Entity Type | Individual
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Provider Name | YADID CHANIZ-RICO
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Gender |
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Dates
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Enumeration Date | 03/03/2025
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Last Update Date | 03/03/2025
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Provider Practice Location Address
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Address Line | 750 ROUTE 73 S STE 210
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City | EVESHAM
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State | NJ
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Zip | 08053-4133
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Country | US
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Telephone | 856-399-1010
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Fax |
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Provider Business Mailing Address
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Address Line | 924 CEDAR ST
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City | CAMDEN
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State | NJ
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Zip | 08102-1730
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Country | US
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Telephone |
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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 | 44SL06768600
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License Number State | NJ
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