| Doctor Name: | MR. CHAD A BOOTH |
| NPI Number: | 1083802094 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | LSW |
| License Number: | 33005318A |
| Business Practice Address: | 450 Saint John Rd Michigan City, IN - 463607354 |
| Business Phone Number: | 2198728666 |
| Business Fax Number: | |
| Mailing Address: | 1072 Jesse Bartlett Ct, CROWN POINT |
| State: | IN |
| Postal Code: | 463077515 |
| Phone Number: | 2198728666 |
| Fax Number: | |
| NPI Enumeration Date: | 10/04/2007 |
| NPI Last Update Date: | 10/04/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | 33005318A |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IN |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |