Basic Information
| Provider Information | |||||||||
| NPI: | 1275176257 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHAVARRIA | ||||||||
| FirstName: | KENIA | ||||||||
| MiddleName: | ELIZABETH | ||||||||
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| Credential: | MHSA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 17250 SW 248TH ST | ||||||||
| Address2: | |||||||||
| City: | HOMESTEAD | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330311902 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3057473725 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 99198 OVERSEAS HWY | ||||||||
| Address2: | |||||||||
| City: | KEY LARGO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330372437 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3054347660 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/23/2019 | ||||||||
| LastUpdateDate: | 10/23/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171M00000X | Y | Other Service Providers | Case Manager/Care Coordinator |
No ID Information.