Provider Demographics
NPI:1487715603
Name:CHASE, CAROLA BERNSTEIN (MSW)
Entity type:Individual
Prefix:MS
First Name:CAROLA
Middle Name:BERNSTEIN
Last Name:CHASE
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2575 PALISADE AVE
Mailing Address - Street 2:APT. 7G
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-6101
Mailing Address - Country:US
Mailing Address - Phone:212-769-4758
Mailing Address - Fax:718-796-2085
Practice Address - Street 1:350 CENTRAL PARK W
Practice Address - Street 2:SUITE 1C
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-6547
Practice Address - Country:US
Practice Address - Phone:212-769-4758
Practice Address - Fax:718-796-2085
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2008-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPRO22253-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYNO6311Medicare ID - Type UnspecifiedSOCIAL WORK