Provider Demographics
NPI:1275176257
Name:CHAVARRIA, KENIA ELIZABETH (MHSA)
Entity Type:Individual
Prefix:
First Name:KENIA
Middle Name:ELIZABETH
Last Name:CHAVARRIA
Suffix:
Gender:F
Credentials:MHSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17250 SW 248TH ST
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33031-1902
Mailing Address - Country:US
Mailing Address - Phone:305-747-3725
Mailing Address - Fax:
Practice Address - Street 1:99198 OVERSEAS HWY
Practice Address - Street 2:
Practice Address - City:KEY LARGO
Practice Address - State:FL
Practice Address - Zip Code:33037-2437
Practice Address - Country:US
Practice Address - Phone:305-434-7660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-23
Last Update Date:2019-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator