Provider Demographics
NPI:1053010546
Name:CHAMORRO, ASHLEY CAROLINA
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:CAROLINA
Last Name:CHAMORRO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:567 NW LAKE WHITNEY PL
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34986-1629
Mailing Address - Country:US
Mailing Address - Phone:772-207-0823
Mailing Address - Fax:
Practice Address - Street 1:1818 SW MORELIA LN
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34953-2082
Practice Address - Country:US
Practice Address - Phone:772-207-0823
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-23
Last Update Date:2023-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist