Provider Demographics
NPI:1154105369
Name:MBENGONE MENGARA, CHANCELEVIA VERENE
Entity type:Individual
Prefix:MISS
First Name:CHANCELEVIA
Middle Name:VERENE
Last Name:MBENGONE MENGARA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 INTERNATIONAL DR
Mailing Address - Street 2:
Mailing Address - City:BUDD LAKE
Mailing Address - State:NJ
Mailing Address - Zip Code:07828-1383
Mailing Address - Country:US
Mailing Address - Phone:833-282-2223
Mailing Address - Fax:
Practice Address - Street 1:133 LANDING RD APT 1L
Practice Address - Street 2:
Practice Address - City:LANDING
Practice Address - State:NJ
Practice Address - Zip Code:07850-1509
Practice Address - Country:US
Practice Address - Phone:318-418-3682
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-21
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician