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General NPI Number Information
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NPI Number | 1982161279
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Entity Type | Individual
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Provider Name | MARIE CHACON
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Gender | Female
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Dates
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Enumeration Date | 02/22/2019
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Last Update Date | 06/04/2024
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Provider Practice Location Address
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Address Line | 2901 NW 24TH AVE
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City | CAPE CORAL
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State | FL
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Zip | 33993-8380
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Country | US
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Telephone | 305-615-9297
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Fax |
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Provider Business Mailing Address
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Address Line | 6280 NW 173RD ST APT 1235
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City | HIALEAH
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State | FL
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Zip | 33015-4566
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Country | US
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Telephone | 305-615-9297
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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 | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-24-73351
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 106E00000X
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Taxonomy Name | Assistant Behavior Analyst
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License Number | 0-22-13524
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License Number State | FL
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