Provider Demographics
NPI:1265210348
Name:CHAFFARDET, MICHELLE
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:CHAFFARDET
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 1:126 HIGHLAND ST
Mailing Address - Street 2:
Mailing Address - City:COCOA
Mailing Address - State:FL
Mailing Address - Zip Code:32922-7523
Mailing Address - Country:US
Mailing Address - Phone:305-970-5519
Mailing Address - Fax:305-970-5519
Practice Address - Street 1:126 HIGHLAND ST
Practice Address - Street 2:
Practice Address - City:COCOA
Practice Address - State:FL
Practice Address - Zip Code:32922-7523
Practice Address - Country:US
Practice Address - Phone:305-970-5519
Practice Address - Fax:305-970-5519
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-19
Last Update Date:2025-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT4716103TP2701X, 106H00000X, 101YM0800X, 103T00000X, 103TA0700X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & Aging
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent