MEDICARE: ANTONY CHATHAM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	SW8156	FL

General Provider Information

NPI Number	:	1548565674
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANTONY CHATHAM

Provider Business Mailing Address
First Line	:	3462 HARNESS CIR
Second Line	:
City	:	WELLINGTON
State	:	FL
Zip	:	33449-8028
Country	:	US
Telephone Number	:	561-329-4774
Fax Number	:

Provider Business Practice Location Address
First Line	:	1443 PALMDALE CT
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33411-3319
Country	:	US
Telephone Number	:	561-471-5867
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/21/2011
Last Update Date	:	01/21/2011

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Directions to “ ANTONY CHATHAM ” Practice Location

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