Provider Demographics
NPI:1811125594
Name:CHABIN, BRODERICK STEPHEN (MA)
Entity type:Individual
Prefix:MR
First Name:BRODERICK
Middle Name:STEPHEN
Last Name:CHABIN
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1433 N HARPER AVE
Mailing Address - Street 2:UNIT # 4
Mailing Address - City:WEST HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90046-3765
Mailing Address - Country:US
Mailing Address - Phone:323-369-8838
Mailing Address - Fax:
Practice Address - Street 1:1433 N HARPER AVE
Practice Address - Street 2:UNIT # 4
Practice Address - City:WEST HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90046-3765
Practice Address - Country:US
Practice Address - Phone:323-369-8838
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-01
Last Update Date:2009-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF:52507106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist