Provider Demographics
NPI:1871943878
Name:CHASE, STEPHEN (DSW, LCSW)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:
Last Name:CHASE
Suffix:
Gender:M
Credentials:DSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 MDOS/ SGOW
Mailing Address - Street 2:1370 SOUTH PATRICK DR
Mailing Address - City:PATRICK AFB
Mailing Address - State:FL
Mailing Address - Zip Code:32925
Mailing Address - Country:US
Mailing Address - Phone:321-494-8171
Mailing Address - Fax:321-494-8074
Practice Address - Street 1:45 MDOS/ SGOW
Practice Address - Street 2:1370 SOUTH PATRICK DR
Practice Address - City:PATRICK AFB
Practice Address - State:FL
Practice Address - Zip Code:32925
Practice Address - Country:US
Practice Address - Phone:321-494-8171
Practice Address - Fax:321-494-8074
Is Sole Proprietor?:No
Enumeration Date:2016-06-21
Last Update Date:2016-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL113921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical