MEDICARE: CHAE DANIELLE REID R-DMT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225600000X	Dance Therapist	2880
2	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1457120438
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHAE DANIELLE REID R-DMT

Provider Business Mailing Address
First Line	:	1100 E PARK AVE
Second Line	:
City	:	VINELAND
State	:	NJ
Zip	:	08360-3322
Country	:	US
Telephone Number	:	856-305-4679
Fax Number	:

Provider Business Practice Location Address
First Line	:	1100 E PARK AVE
Second Line	:
City	:	VINELAND
State	:	NJ
Zip	:	08360-3322
Country	:	US
Telephone Number	:	856-305-4679
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/01/2024
Last Update Date	:	01/01/2024

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