| Doctor Name: | CHASE BRAD GIRVIN |
| NPI Number: | 1003103052 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | LMHC, CASAC |
| License Number: | 13-03-21 |
| Business Practice Address: | 1167 Nostrand Ave Brooklyn, NY - 112255417 |
| Business Phone Number: | 7187780198 |
| Business Fax Number: | 7182218169 |
| Mailing Address: | 60 Madison Ave, 5th Floor NEW YORK |
| State: | NY |
| Postal Code: | 100101600 |
| Phone Number: | 2125452400 |
| Fax Number: | 6463120481 |
| NPI Enumeration Date: | 06/28/2011 |
| NPI Last Update Date: | 12/17/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | 13-03-21 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | OR |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |