MEDICARE: MRS. BETH ROSE CHASSIN MSW, LCSW

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	44SC05259900	NJ
2	1041C0700X	Clinical Social Worker	SW10527	FL

General Provider Information

NPI Number	:	1215213673
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. BETH ROSE CHASSIN MSW, LCSW

Provider Business Mailing Address
First Line	:	9790 VIA AMATI
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33467
Country	:	US
Telephone Number	:	561-366-7404
Fax Number	:	561-366-7405

Provider Business Practice Location Address
First Line	:	9790 VIA AMATI
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33467
Country	:	US
Telephone Number	:	561-366-7404
Fax Number	:	561-366-7405

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

Provider Enumeration Date	:	10/31/2011
Last Update Date	:	10/01/2019

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