Healthcare Provider Details

I. General information

NPI: 1720227135
Provider Name (Legal Business Name): CLAUDIA CATHERINE CHICCO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CLAUDIA CATHERINE REYNOLDS LCSW

II. Dates (important events)

Enumeration Date: 02/09/2009
Last Update Date: 02/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 KNUTH RD STE 232
BOYNTON BEACH FL
33436-4637
US

IV. Provider business mailing address

200 KNUTH RD STE 232
BOYNTON BEACH FL
33436-4637
US

V. Phone/Fax

Practice location:
  • Phone: 561-714-8578
  • Fax:
Mailing address:
  • Phone: 561-714-8579
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW5611
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: