Provider Demographics
NPI:1447446075
Name:JAROSLAWICZ, CHAYA GOLDY (LCSW)
Entity type:Individual
Prefix:
First Name:CHAYA
Middle Name:GOLDY
Last Name:JAROSLAWICZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1771 MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701
Mailing Address - Country:US
Mailing Address - Phone:732-364-2144
Mailing Address - Fax:732-364-3559
Practice Address - Street 1:1771 MADISON AVE
Practice Address - Street 2:CENTER FOR HEALTH EDUCATION, MEDICINE AND DENTISTRY
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701
Practice Address - Country:US
Practice Address - Phone:732-364-2144
Practice Address - Fax:732-364-3559
Is Sole Proprietor?:No
Enumeration Date:2007-09-18
Last Update Date:2012-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC053072001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical