Healthcare Provider Details

I. General information

NPI: 1528977808
Provider Name (Legal Business Name): THEASA CHAVERS ISW23777
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2026
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 W MAGNOLIA AVE # 101
LONGWOOD FL
32750-4130
US

IV. Provider business mailing address

534 HUNGERFORD BLVD
ORLANDO FL
32810-6203
US

V. Phone/Fax

Practice location:
  • Phone: 407-215-0095
  • Fax:
Mailing address:
  • Phone: 321-305-8878
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberISW23777
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: