Provider Demographics
NPI:1861187510
Name:CHIU, CHANTEL IVELISSE (PSY D)
Entity type:Individual
Prefix:
First Name:CHANTEL
Middle Name:IVELISSE
Last Name:CHIU
Suffix:
Gender:F
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15325 NW 60TH AVE STE 105
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33014-2470
Mailing Address - Country:US
Mailing Address - Phone:305-512-5388
Mailing Address - Fax:305-512-5390
Practice Address - Street 1:15325 NW 60TH AVE STE 105
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33014-2470
Practice Address - Country:US
Practice Address - Phone:305-512-5388
Practice Address - Fax:305-512-5390
Is Sole Proprietor?:No
Enumeration Date:2023-04-10
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY10418103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical