Provider Demographics
NPI:1104997303
Name:CHABOT, JOHN ALAN (PHD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ALAN
Last Name:CHABOT
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 WAGON WHEEL LN
Mailing Address - Street 2:
Mailing Address - City:DIX HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11746-5016
Mailing Address - Country:US
Mailing Address - Phone:631-499-3548
Mailing Address - Fax:
Practice Address - Street 1:21 WAGON WHEEL LN
Practice Address - Street 2:
Practice Address - City:DIX HILLS
Practice Address - State:NY
Practice Address - Zip Code:11746-5016
Practice Address - Country:US
Practice Address - Phone:613-499-3548
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY4939103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYV22031Medicare ID - Type Unspecified