Provider Demographics
NPI:1922531219
Name:CHASTAIN, MARJORIE (LCSW)
Entity type:Individual
Prefix:MS
First Name:MARJORIE
Middle Name:
Last Name:CHASTAIN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:MARJORIE
Other - Middle Name:
Other - Last Name:NEJMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LSW
Mailing Address - Street 1:1351 FAIRVIEW BLVD STE A
Mailing Address - Street 2:#1094
Mailing Address - City:DELRAN
Mailing Address - State:NJ
Mailing Address - Zip Code:08075-1475
Mailing Address - Country:US
Mailing Address - Phone:856-444-5139
Mailing Address - Fax:
Practice Address - Street 1:1351 FAIRVIEW BLVD. STE A
Practice Address - Street 2:#1094
Practice Address - City:DELRAN
Practice Address - State:NJ
Practice Address - Zip Code:08075-1475
Practice Address - Country:US
Practice Address - Phone:856-444-5139
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-04
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC061497001041C0700X
PACW0228441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical