Basic Information
| Provider Information | |||||||||
| NPI: | 1689171555 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | AUSTIN | ||||||||
| FirstName: | CHENEEN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6550 DELILAH RD STE 301 | ||||||||
| Address2: | |||||||||
| City: | EGG HARBOR TOWNSHIP | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 082345102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6092728580 | ||||||||
| FaxNumber: | 6096457343 | ||||||||
| Practice Location | |||||||||
| Address1: | 120 S WHITE HORSE PIKE | ||||||||
| Address2: | |||||||||
| City: | HAMMONTON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080371804 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6095617911 | ||||||||
| FaxNumber: | 6096457343 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/09/2018 | ||||||||
| LastUpdateDate: | 09/11/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 26NR13760400 | NJ | N | Nursing Service Providers | Registered Nurse | 364SP0808X | 26NJ00852900 | NJ | Y | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Psych/Mental Health |
No ID Information.