Provider Demographics
NPI:1184171035
Name:CHASE, ANN (LICSW)
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:
Last Name:CHASE
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:ANN
Other - Middle Name:CHASE
Other - Last Name:BALLANTINE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:268 FISKE ST
Mailing Address - Street 2:
Mailing Address - City:CARLISLE
Mailing Address - State:MA
Mailing Address - Zip Code:01741-1019
Mailing Address - Country:US
Mailing Address - Phone:978-505-4819
Mailing Address - Fax:
Practice Address - Street 1:97 LOWELL RD
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:MA
Practice Address - Zip Code:01742-1733
Practice Address - Country:US
Practice Address - Phone:978-505-4819
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-08
Last Update Date:2024-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker