Healthcare Provider Details

I. General information

NPI: 1780501072
Provider Name (Legal Business Name): CHASE MARTIN SCOTT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2026
Last Update Date: 07/03/2026
Certification Date: 07/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 N FEDERAL HWY STE 300
BOCA RATON FL
33432-1994
US

IV. Provider business mailing address

7770 NW 4TH ST
PLANTATION FL
33324-1902
US

V. Phone/Fax

Practice location:
  • Phone: 754-202-2565
  • Fax: 754-209-2738
Mailing address:
  • Phone: 754-202-2565
  • Fax: 754-209-2738

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberMH27994
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: