Healthcare Provider Details

I. General information

NPI: 1124560438
Provider Name (Legal Business Name): BRIAN CHAITIN RMHCI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/17/2016
Last Update Date: 11/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1078 SIENA OAKS CIRCLE EAST
PALM BEACH GARDENS FL
33410
US

IV. Provider business mailing address

1078 SIENA OAKS CIR E
PALM BEACH GARDENS FL
33410-5135
US

V. Phone/Fax

Practice location:
  • Phone: 561-603-5125
  • Fax:
Mailing address:
  • Phone: 561-603-5125
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberIMH 14240
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: