Seraphim Chemodakov, MA LAC
Counselor, Mental Health in East Brunswick, NJ. Individual provider (NPI-1).
NPI number1104397967
StatusActive
Last updated in NPPESDec 5, 2018
Details
- NPI
- 1104397967
- Entity type
- Individual (NPI-1)
- Name
- Seraphim Chemodakov
- Credential
- MA LAC
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Dec 5, 2018
- Last updated
- Dec 5, 2018
Medicare and OIG
- Medicare enrolled (PECOS)
- Yes · PRACTITIONER - MARRIAGE AND FAMILY THERAPIST
- Can order and refer
- Part B Yes · DME Yes · Home health No · Power mobility No · Hospice No
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 101YM0800X | Counselor, Mental Health | 37AC00445600 | NJ | Yes |
Practice location
15 W Prospect St Ste 2East Brunswick, NJ 08816-2161
Phone 732-254-0600
Mailing address
32 Irene BlvdHowell, NJ 07731-2417
Phone 732-580-1586
Is something wrong?
This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
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All 61 Mental Health Counselor providers in East Brunswick · All 2,118 providers in East Brunswick
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