Provider Demographics
NPI:1811628068
Name:OMER, CHELSEA LYN
Entity Type:Individual
Prefix:
First Name:CHELSEA
Middle Name:LYN
Last Name:OMER
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 1:952 SANCTUARY COVE DR
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33410-4517
Mailing Address - Country:US
Mailing Address - Phone:561-281-9260
Mailing Address - Fax:
Practice Address - Street 1:1818 S AUSTRALIAN AVE STE 420
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33409-6447
Practice Address - Country:US
Practice Address - Phone:561-708-5880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-20
Last Update Date:2022-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-20-110731106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician