Provider Demographics
NPI:1093004947
Name:CHAVEZ, SEBASTIAN PAUL (MHC)
Entity Type:Individual
Prefix:PROF
First Name:SEBASTIAN
Middle Name:PAUL
Last Name:CHAVEZ
Suffix:
Gender:M
Credentials:MHC
Other - Prefix:
Other - First Name:SHLOMO
Other - Middle Name:
Other - Last Name:CHAVEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MHC
Mailing Address - Street 1:2925A KINGS HWY
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-1805
Mailing Address - Country:US
Mailing Address - Phone:718-382-0045
Mailing Address - Fax:
Practice Address - Street 1:2925A KINGS HWY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-1805
Practice Address - Country:US
Practice Address - Phone:718-382-0045
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-31
Last Update Date:2011-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP79030101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health