Provider Demographics
NPI:1174006316
Name:CHANCE, ANTHONY RAY (MSW)
Entity Type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:RAY
Last Name:CHANCE
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91-1224 KAIHUOPALAAI ST
Mailing Address - Street 2:
Mailing Address - City:EWA BEACH
Mailing Address - State:HI
Mailing Address - Zip Code:96706-3521
Mailing Address - Country:US
Mailing Address - Phone:808-628-0937
Mailing Address - Fax:
Practice Address - Street 1:91-1224 KAIHUOPALAAI ST
Practice Address - Street 2:
Practice Address - City:EWA BEACH
Practice Address - State:HI
Practice Address - Zip Code:96706-3521
Practice Address - Country:US
Practice Address - Phone:808-628-0937
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-13
Last Update Date:2018-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst