MEDICARE: MARIANNE CHAPMAN LMHC

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	101YM0800X	Mental Health Counselor	MH 4092	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	59-3719429	OTHER	FL	TAX ID #
2	MH4092	OTHER	FL	STATE OF FL-LICENSE #
3	Z7649	OTHER	FL	BCBS OF FL-PROVIDER #

General Provider Information

NPI Number	:	1619198660
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIANNE CHAPMAN LMHC

Provider Business Mailing Address
First Line	:	1820 SEVILLA BLVD
Second Line	:	SUITE 207
City	:	ATLANTIC BEACH
State	:	FL
Zip	:	32233-5636
Country	:	US
Telephone Number	:	904-716-2949
Fax Number	:	931-459-2326

Provider Business Practice Location Address
First Line	:	300 SEVILLA AVE
Second Line	:	SUITE 209
City	:	CORAL GABLES
State	:	FL
Zip	:	33134-6636
Country	:	US
Telephone Number	:	904-710-9420
Fax Number	:	931-459-2326

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

Provider Enumeration Date	:	05/01/2007
Last Update Date	:	08/06/2009

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