Provider Demographics
NPI:1124236351
Name:CHABOT, MICHAEL W (MSW, LCSW)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:W
Last Name:CHABOT
Suffix:
Gender:M
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 HADDONTOWNE CT
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08034-3602
Mailing Address - Country:US
Mailing Address - Phone:609-338-3281
Mailing Address - Fax:856-427-0089
Practice Address - Street 1:100 HADDONTOWNE CT
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08034-3602
Practice Address - Country:US
Practice Address - Phone:856-208-7523
Practice Address - Fax:856-427-0089
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-20
Last Update Date:2020-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC046827001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2548145OtherAETNA INSURANCE
NJ184194OtherCOMPSYCH INSURANCE
NJ2548145OtherAETNA INSURANCE
NJ051649Medicare UPIN
NJ051649Medicare ID - Type Unspecified