Provider Demographics
NPI:1679507313
Name:CHAFFIN, IRIS GALE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:IRIS
Middle Name:GALE
Last Name:CHAFFIN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8140 TERRACE GARDEN DR N APT 204
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33709-1076
Mailing Address - Country:US
Mailing Address - Phone:727-244-3971
Mailing Address - Fax:
Practice Address - Street 1:5682 BEE RIDGE RD STE 100
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34233-1500
Practice Address - Country:US
Practice Address - Phone:941-371-3349
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW68381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical