Provider Demographics
NPI:1437833191
Name:CHEN, PICHTHYDA
Entity Type:Individual
Prefix:
First Name:PICHTHYDA
Middle Name:
Last Name:CHEN
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 1:10961 BURNT MILL RD APT 627
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-4668
Mailing Address - Country:US
Mailing Address - Phone:904-859-0308
Mailing Address - Fax:
Practice Address - Street 1:1904 FARRAGUT PL
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-3420
Practice Address - Country:US
Practice Address - Phone:904-859-0308
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-13
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician