Provider Demographics
NPI:1487055570
Name:CHAVEZ, FELIPA (PSY-D)
Entity type:Individual
Prefix:
First Name:FELIPA
Middle Name:
Last Name:CHAVEZ
Suffix:
Gender:F
Credentials:PSY-D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 W UNIVERSITY BLVD
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-6982
Mailing Address - Country:US
Mailing Address - Phone:321-674-8106
Mailing Address - Fax:312-674-8411
Practice Address - Street 1:404 E MAIN ST
Practice Address - Street 2:
Practice Address - City:GREENTOWN
Practice Address - State:IN
Practice Address - Zip Code:46936-1258
Practice Address - Country:US
Practice Address - Phone:765-628-7400
Practice Address - Fax:765-628-7401
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-09
Last Update Date:2014-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY8227103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical