Provider Demographics
NPI:1396078960
Name:CHAIT, JACQUELINE (M ED)
Entity type:Individual
Prefix:MS
First Name:JACQUELINE
Middle Name:
Last Name:CHAIT
Suffix:
Gender:F
Credentials:M ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:137 FRANCES ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04102-2511
Mailing Address - Country:US
Mailing Address - Phone:207-773-4725
Mailing Address - Fax:
Practice Address - Street 1:137 FRANCES ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102-2511
Practice Address - Country:US
Practice Address - Phone:207-773-4725
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-14
Last Update Date:2009-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME222050000Medicaid