Provider Demographics
NPI:1124560438
Name:CHAITIN, BRIAN (RMHCI)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:
Last Name:CHAITIN
Suffix:
Gender:M
Credentials:RMHCI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1078 SIENA OAKS CIR E
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-5135
Mailing Address - Country:US
Mailing Address - Phone:561-603-5125
Mailing Address - Fax:
Practice Address - Street 1:1078 SIENA OAKS CIRCLE EAST
Practice Address - Street 2:
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410
Practice Address - Country:US
Practice Address - Phone:561-603-5125
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-17
Last Update Date:2016-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH 14240101YM0800X
FL247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health