Provider Demographics
NPI:1043304876
Name:THOMAS CHEMRIS, LCSW,LLC
Entity type:Organization
Organization Name:THOMAS CHEMRIS, LCSW,LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:WALTER
Authorized Official - Last Name:CHEMRIS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW,LCADC
Authorized Official - Phone:732-938-3080
Mailing Address - Street 1:PO BOX 361
Mailing Address - Street 2:
Mailing Address - City:ALLENWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08720-0361
Mailing Address - Country:US
Mailing Address - Phone:732-938-3080
Mailing Address - Fax:732-938-3080
Practice Address - Street 1:1613 RTE 88 WEST SUITE6
Practice Address - Street 2:
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08724
Practice Address - Country:US
Practice Address - Phone:732-938-3080
Practice Address - Fax:732-938-3085
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2008-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC05184500101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ090593Medicare PIN