Provider Demographics
NPI:1275035495
Name:BAIN-CHASE, MARY ELIZABETH (YMCA EMPLOYEE)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:ELIZABETH
Last Name:BAIN-CHASE
Suffix:
Gender:F
Credentials:YMCA EMPLOYEE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 CENTER RD
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34285-4808
Mailing Address - Country:US
Mailing Address - Phone:941-492-9622
Mailing Address - Fax:941-496-8028
Practice Address - Street 1:701 CENTER RD
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34285-4808
Practice Address - Country:US
Practice Address - Phone:941-492-9622
Practice Address - Fax:941-496-8028
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-03
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator