Provider Demographics
NPI:1508901018
Name:CHANCE, BRIAN F (LICSW)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:F
Last Name:CHANCE
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 BREEDS HILL RD
Mailing Address - Street 2:
Mailing Address - City:HYANNIS
Mailing Address - State:MA
Mailing Address - Zip Code:02601-1881
Mailing Address - Country:US
Mailing Address - Phone:508-775-0275
Mailing Address - Fax:
Practice Address - Street 1:206 BREEDS HILL RD
Practice Address - Street 2:
Practice Address - City:HYANNIS
Practice Address - State:MA
Practice Address - Zip Code:02601-1881
Practice Address - Country:US
Practice Address - Phone:508-775-0275
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1076061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical