Provider Demographics
NPI:1912415027
Name:LANCRY, CHLOE
Entity Type:Individual
Prefix:
First Name:CHLOE
Middle Name:
Last Name:LANCRY
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 1:2181 NE 67TH ST APT 625
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-1130
Mailing Address - Country:US
Mailing Address - Phone:954-822-6433
Mailing Address - Fax:
Practice Address - Street 1:2011 NE 60TH ST
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-2127
Practice Address - Country:US
Practice Address - Phone:954-614-1398
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-11
Last Update Date:2018-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst