Provider Demographics
NPI:1245432012
Name:DRIZIN, CHAIM
Entity Type:Individual
Prefix:MR
First Name:CHAIM
Middle Name:
Last Name:DRIZIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2699 STIRLING RD
Mailing Address - Street 2:C-305A
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33312-6517
Mailing Address - Country:US
Mailing Address - Phone:786-999-3535
Mailing Address - Fax:
Practice Address - Street 1:2699 STIRLING RD
Practice Address - Street 2:C-305A
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33312-6517
Practice Address - Country:US
Practice Address - Phone:786-999-3535
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-04
Last Update Date:2016-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL794106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist