Healthcare Provider Details

I. General information

NPI: 1598552879
Provider Name (Legal Business Name): IRIS VICTORIA CHASE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2025
Last Update Date: 04/22/2025
Certification Date: 04/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1651 E MOUNT AIRY AVE
PHILADELPHIA PA
19150-1103
US

IV. Provider business mailing address

1651 E MOUNT AIRY AVE
PHILADELPHIA PA
19150-1103
US

V. Phone/Fax

Practice location:
  • Phone: 267-407-7769
  • Fax:
Mailing address:
  • Phone: 267-407-7769
  • Fax: 267-407-7769

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: