Provider Demographics
NPI:1053935056
Name:CHASE, DARIA (PHD)
Entity type:Individual
Prefix:
First Name:DARIA
Middle Name:
Last Name:CHASE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 HOLLY LN
Mailing Address - Street 2:
Mailing Address - City:DARIEN
Mailing Address - State:CT
Mailing Address - Zip Code:06820-3303
Mailing Address - Country:US
Mailing Address - Phone:646-633-1586
Mailing Address - Fax:
Practice Address - Street 1:158 CAMBRIDGE AVE
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530-4235
Practice Address - Country:US
Practice Address - Phone:646-633-1586
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-04
Last Update Date:2020-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023439103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical