1053908954 NPI number — MS. CELANIE RICARDINE CHENET LMHC

Table of content: MS. CELANIE RICARDINE CHENET LMHC (NPI 1053908954)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053908954 NPI number — MS. CELANIE RICARDINE CHENET LMHC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHENET
Provider First Name:
CELANIE
Provider Middle Name:
RICARDINE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LMHC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1053908954
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/15/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4546 N FEDERAL HWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FORT LAUDERDALE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33308-5204
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
954-716-6514
Provider Business Mailing Address Fax Number:
754-223-2984

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3160 POWERLINE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OAKLAND PARK
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33309-5911
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-567-7141
Provider Business Practice Location Address Fax Number:
954-565-5624
Provider Enumeration Date:
12/26/2020

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  MH18697 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: Z01PC . This is a "MENTAL HEALTH" identifier . This identifiers is of the category "OTHER".




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