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NPI Code Detail

MEDICARE: MR. BRODERICK STEPHEN CHABIN M.A.

MEDICARE: MR. BRODERICK STEPHEN CHABIN M.A.
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
1106H00000XMarriage & Family TherapistIMF:52507CA

General Provider Information

NPI Number : 1811125594
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. BRODERICK STEPHEN CHABIN M.A.
Provider Business Mailing Address
First Line : 1433 N HARPER AVE
Second Line : UNIT # 4
City : WEST HOLLYWOOD
State : CA
Zip : 90046-3765
Country : US
Telephone Number : 323-369-8838
Fax Number :
Provider Business Practice Location Address
First Line : 1433 N HARPER AVE
Second Line : UNIT # 4
City : WEST HOLLYWOOD
State : CA
Zip : 90046-3765
Country : US
Telephone Number : 323-369-8838
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/01/2009
Last Update Date : 07/01/2009

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