Provider Demographics
NPI:1558877415
Name:WAREHALL, CHLOE (BS; MB, BCH, BAO)
Entity Type:Individual
Prefix:
First Name:CHLOE
Middle Name:
Last Name:WAREHALL
Suffix:
Gender:F
Credentials:BS; MB, BCH, BAO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 FRUIT ST
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114-2696
Mailing Address - Country:US
Mailing Address - Phone:617-726-2800
Mailing Address - Fax:
Practice Address - Street 1:55 FRUIT ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2696
Practice Address - Country:US
Practice Address - Phone:617-726-2800
Practice Address - Fax:617-724-3499
Is Sole Proprietor?:No
Enumeration Date:2017-12-14
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CABACB401629106S00000X
MA292965208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician