Provider Demographics
NPI:1861774937
Name:CHAIM, CONSTANCE JOHANNA (PSYD)
Entity type:Individual
Prefix:
First Name:CONSTANCE
Middle Name:JOHANNA
Last Name:CHAIM
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 AVE WINSTON CHURCHILL
Mailing Address - Street 2:STE. 1PMB 202
Mailing Address - City:RIO PIEDRAS
Mailing Address - State:PR
Mailing Address - Zip Code:00926-6018
Mailing Address - Country:US
Mailing Address - Phone:787-466-2981
Mailing Address - Fax:
Practice Address - Street 1:867 AVE MUNOZ RIVERA
Practice Address - Street 2:STE. B 102
Practice Address - City:RIO PIEDRAS
Practice Address - State:PR
Practice Address - Zip Code:00925-2102
Practice Address - Country:US
Practice Address - Phone:787-466-2981
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-15
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2237103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical