Provider Demographics
NPI:1306675830
Name:CHAMORRO, SERGIO ANDRES
Entity type:Individual
Prefix:
First Name:SERGIO
Middle Name:ANDRES
Last Name:CHAMORRO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:455 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:RIDGEFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07657-2648
Mailing Address - Country:US
Mailing Address - Phone:551-331-7919
Mailing Address - Fax:
Practice Address - Street 1:455 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:RIDGEFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07657-2648
Practice Address - Country:US
Practice Address - Phone:551-331-7919
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-01
Last Update Date:2024-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst