Healthcare Provider Details

I. General information

NPI: 1881743722
Provider Name (Legal Business Name): TINA CHASE MFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 WEST AVE
SARATOGA SPRINGS NY
12866-6045
US

IV. Provider business mailing address

1 WEST AVE
SARATOGA SPRINGS NY
12866-6045
US

V. Phone/Fax

Practice location:
  • Phone: 518-581-8699
  • Fax: 518-581-8783
Mailing address:
  • Phone: 518-581-8699
  • Fax: 518-581-8783

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number160
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFCC 18247
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: