MEDICARE: MARISOL CHINCHAY LAMFT

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	106H00000X	Marriage & Family Therapist	37FA00022700	NJ

General Provider Information

NPI Number	:	1639934961
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARISOL CHINCHAY LAMFT

Provider Business Mailing Address
First Line	:	440 FRANKLIN ST STE 200
Second Line	:
City	:	BLOOMFIELD
State	:	NJ
Zip	:	07003-4379
Country	:	US
Telephone Number	:	973-746-0800
Fax Number	:

Provider Business Practice Location Address
First Line	:	440 FRANKLIN ST STE 200
Second Line	:
City	:	BLOOMFIELD
State	:	NJ
Zip	:	07003-4379
Country	:	US
Telephone Number	:	973-746-0800
Fax Number	:	973-746-2822

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

Provider Enumeration Date	:	02/15/2024
Last Update Date	:	02/15/2024

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Directions to “ MARISOL CHINCHAY LAMFT” Practice Location

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