Provider Demographics
NPI:1083128573
Name:SOLIS, CHLOE JEAN (MD, LCSW)
Entity type:Individual
Prefix:
First Name:CHLOE
Middle Name:JEAN
Last Name:SOLIS
Suffix:
Gender:F
Credentials:MD, LCSW
Other - Prefix:
Other - First Name:CHLOE
Other - Middle Name:ALICE
Other - Last Name:JEAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1881 SE TIFFANY AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34952-7567
Mailing Address - Country:US
Mailing Address - Phone:772-398-7936
Mailing Address - Fax:772-398-7970
Practice Address - Street 1:1881 SE TIFFANY AVE STE 102
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-7567
Practice Address - Country:US
Practice Address - Phone:772-398-7936
Practice Address - Fax:772-398-7970
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-20
Last Update Date:2025-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW148231041C0700X
FLME175814207QA0505X
FLTRN36735390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine