Provider Demographics
NPI:1720105356
Name:CHASE, JOAN B (EDD)
Entity Type:Individual
Prefix:DR
First Name:JOAN
Middle Name:B
Last Name:CHASE
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2598 GARY CIRCLE
Mailing Address - Street 2:SUITE 504
Mailing Address - City:DUNEDIN
Mailing Address - State:FL
Mailing Address - Zip Code:34698-1790
Mailing Address - Country:US
Mailing Address - Phone:727-733-7771
Mailing Address - Fax:
Practice Address - Street 1:2598 GARY CIRCLE
Practice Address - Street 2:SUITE 504
Practice Address - City:DUNEDIN
Practice Address - State:FL
Practice Address - Zip Code:34698-1790
Practice Address - Country:US
Practice Address - Phone:727-733-7771
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY5354103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist