MEDICARE: JENNIFER CHINAGIA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number State
1	101YP2500X	Professional Counselor
2	106S00000X	Behavior Technician
3	103K00000X	Behavior Analyst
4	106S00000X	Behavior Technician	AZ

General Provider Information

NPI Number	:	1205390275
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER CHINAGIA

Provider Business Mailing Address
First Line	:	5151 E GUADALUPE RD APT 2055
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85044-7725
Country	:	US
Telephone Number	:	314-210-9813
Fax Number	:

Provider Business Practice Location Address
First Line	:	5151 E GUADALUPE RD APT 2055
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85044-7725
Country	:	US
Telephone Number	:	314-210-9813
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/24/2019
Last Update Date	:	01/24/2019

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Directions to “ JENNIFER CHINAGIA ” Practice Location

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