Provider Demographics
NPI:1932224268
Name:CHANDLER, MARYANN T (LCSW)
Entity Type:Individual
Prefix:
First Name:MARYANN
Middle Name:T
Last Name:CHANDLER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MARYANN
Other - Middle Name:
Other - Last Name:PRIBISH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 10414
Mailing Address - Street 2:C O PARADIGM HEALTH SERVICES
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33773-0414
Mailing Address - Country:US
Mailing Address - Phone:901-737-7373
Mailing Address - Fax:
Practice Address - Street 1:6110 SHALLOWFORD RD
Practice Address - Street 2:C O CRC
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-1615
Practice Address - Country:US
Practice Address - Phone:800-632-6074
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLSW00000042551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3732667Medicare ID - Type UnspecifiedINDIVIDUAL PROVIDER #