Provider Demographics
NPI:1891371753
Name:SALMON CREGO, CHABELY
Entity Type:Individual
Prefix:
First Name:CHABELY
Middle Name:
Last Name:SALMON CREGO
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 1:664 NW 123RD PATH
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33182-2050
Mailing Address - Country:US
Mailing Address - Phone:786-226-4314
Mailing Address - Fax:
Practice Address - Street 1:65821 OVERSEAS HWY #282
Practice Address - Street 2:
Practice Address - City:LONG KEY
Practice Address - State:FL
Practice Address - Zip Code:33001
Practice Address - Country:US
Practice Address - Phone:786-391-1680
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-22
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL20-135788106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty