Provider Demographics
NPI:1215610068
Name:COLON, CHANCEY (BCBA)
Entity type:Individual
Prefix:MRS
First Name:CHANCEY
Middle Name:
Last Name:COLON
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:MRS
Other - First Name:CHANCEY
Other - Middle Name:
Other - Last Name:RIVERA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:BCBA
Mailing Address - Street 1:62 FEDERAL CITY RD
Mailing Address - Street 2:
Mailing Address - City:EWING
Mailing Address - State:NJ
Mailing Address - Zip Code:08638-1322
Mailing Address - Country:US
Mailing Address - Phone:609-903-4927
Mailing Address - Fax:
Practice Address - Street 1:62 FEDERAL CITY RD
Practice Address - Street 2:
Practice Address - City:EWING
Practice Address - State:NJ
Practice Address - Zip Code:08638-1322
Practice Address - Country:US
Practice Address - Phone:609-903-4927
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-09
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty