Provider Demographics
NPI:1396294641
Name:CHAVIS, BRIDGETT
Entity type:Individual
Prefix:
First Name:BRIDGETT
Middle Name:
Last Name:CHAVIS
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 1:75 LA SALLE ST
Mailing Address - Street 2:APARTMENT 9F
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10027-4739
Mailing Address - Country:US
Mailing Address - Phone:646-837-4093
Mailing Address - Fax:
Practice Address - Street 1:75 LA SALLE ST
Practice Address - Street 2:APARTMENT 9F
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10027-4739
Practice Address - Country:US
Practice Address - Phone:646-837-4093
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-28
Last Update Date:2016-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional