MEDICARE: MS. CHANTELLE W NOBLE MASTERS

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	106S00000X	Behavior Technician
2	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1487325239
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CHANTELLE W NOBLE MASTERS

Provider Business Mailing Address
First Line	:	3210 AVENUE H APT 6F
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11210-3242
Country	:	US
Telephone Number	:	347-362-4389
Fax Number	:

Provider Business Practice Location Address
First Line	:	3210 AVENUE H APT 6F
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11210-3242
Country	:	US
Telephone Number	:	347-362-4389
Fax Number	:	914-229-2022

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

Provider Enumeration Date	:	09/22/2021
Last Update Date	:	09/22/2021

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