Provider Demographics
NPI:1538987128
Name:GOODEN-CLYNE, CHASTITY
Entity type:Individual
Prefix:
First Name:CHASTITY
Middle Name:
Last Name:GOODEN-CLYNE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:149 BELLAIR PL APT 2
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07104-1873
Mailing Address - Country:US
Mailing Address - Phone:609-254-4003
Mailing Address - Fax:
Practice Address - Street 1:149 BELLAIR PL APT 2
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07104-1873
Practice Address - Country:US
Practice Address - Phone:609-254-4003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-01
Last Update Date:2024-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula