Provider Demographics
NPI:1124582705
Name:ESTEFAN, CHANDRA (PHD)
Entity Type:Individual
Prefix:DR
First Name:CHANDRA
Middle Name:
Last Name:ESTEFAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 VILABELLA AVE
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33146-1715
Mailing Address - Country:US
Mailing Address - Phone:415-246-5825
Mailing Address - Fax:
Practice Address - Street 1:1 ALHAMBRA PLZ PH FLOOR
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-5216
Practice Address - Country:US
Practice Address - Phone:305-602-4734
Practice Address - Fax:305-317-5919
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-28
Last Update Date:2021-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2034106H00000X
TX202834106H00000X
FLMT4043106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist