Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XM0800X | Mental Health | OT11200 | FL |
NPI | 1396369625 |
---|---|
Provider Name | Chauncey M Joseph |
First Address | Pembroke Pines, FL 33024-7218 |
Second Address | Pembroke Pines, FL 33024-7218 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/06/2020 |
Last Update Date | 02/06/2020 |