Provider Demographics
NPI:1376095703
Name:EDWARDS, CHANTEL
Entity Type:Individual
Prefix:
First Name:CHANTEL
Middle Name:
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 MOORE ST
Mailing Address - Street 2:10 D
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11206-3654
Mailing Address - Country:US
Mailing Address - Phone:347-447-1666
Mailing Address - Fax:
Practice Address - Street 1:140 MOORE ST
Practice Address - Street 2:10 D
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11206-3654
Practice Address - Country:US
Practice Address - Phone:347-447-1666
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-02
Last Update Date:2016-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst