Provider Demographics
NPI:1902954068
Name:CHASSINE, ELIEZER (PHD)
Entity Type:Individual
Prefix:
First Name:ELIEZER
Middle Name:
Last Name:CHASSINE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:ELI
Other - Middle Name:ALAN
Other - Last Name:CHASSINE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:201 W 89TH STREET APT. 2F
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024
Mailing Address - Country:US
Mailing Address - Phone:212-875-9184
Mailing Address - Fax:
Practice Address - Street 1:35 EAST 110TH STREET (3RD FLOOR)
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029
Practice Address - Country:US
Practice Address - Phone:212-426-3469
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY103TS0200X103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool