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General NPI Number Information
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NPI Number | 1790336691
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Entity Type | Individual
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Provider Name | SHAYLA MONIQUE CHASE LCSW
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Gender | Female
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Dates
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Enumeration Date | 09/23/2019
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Last Update Date | 04/02/2022
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Provider Practice Location Address
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Address Line | 1127 STERLING RD
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City | INVERNESS
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State | FL
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Zip | 34450-3979
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Country | US
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Telephone | 352-637-0605
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 711
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City | INVERNESS
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State | FL
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Zip | 34451-0711
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Country | US
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Telephone | 352-637-0605
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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 | SW13664
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License Number State | FL
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