Provider Demographics
NPI:1790177202
Name:CHAVARRO, FREDDY (BA)
Entity Type:Individual
Prefix:
First Name:FREDDY
Middle Name:
Last Name:CHAVARRO
Suffix:
Gender:M
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1551 FORUM PL
Mailing Address - Street 2:400 D&E
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33401-2319
Mailing Address - Country:US
Mailing Address - Phone:561-712-6821
Mailing Address - Fax:561-712-8070
Practice Address - Street 1:237 SW STERRET CIR
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34953-3325
Practice Address - Country:US
Practice Address - Phone:772-626-6847
Practice Address - Fax:561-712-8070
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-21
Last Update Date:2015-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator