Provider Demographics
NPI:1366724361
Name:CHASMAN, JESSE DANIEL (PHD)
Entity type:Individual
Prefix:DR
First Name:JESSE
Middle Name:DANIEL
Last Name:CHASMAN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2520
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29465-2520
Mailing Address - Country:US
Mailing Address - Phone:860-997-4723
Mailing Address - Fax:
Practice Address - Street 1:1608 PARADISE LAKE DR
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-5719
Practice Address - Country:US
Practice Address - Phone:860-997-4723
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPS01247103G00000X
SC1449103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist