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General NPI Number Information
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NPI Number | 1245407261
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Entity Type | Individual
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Provider Name | ELLICE BROOK CHASEN
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Gender | Female
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Dates
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Enumeration Date | 05/08/2008
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Last Update Date | 10/15/2009
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Provider Practice Location Address
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Address Line | 101 SE 16TH AVE APT 6
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City | FORT LAUDERDALE
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State | FL
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Zip | 33301-3912
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Country | US
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Telephone | 954-894-3862
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Fax |
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Provider Business Mailing Address
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Address Line | 101 SE 16TH AVE #6
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City | FORT LAUDERDALE
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State | FL
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Zip | 33301
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Country | US
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Telephone | 954-894-3862
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | SW8954
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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