Individual
MR. CHAD A BOOTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LSW
Contact information
Practice address
450 SAINT JOHN RD, MICHIGAN CITY, IN 46360-7354
(219) 872-8666
Mailing address
1072 JESSE BARTLETT CT, CROWN POINT, IN 46307-7515
(219) 872-8666
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
33005318A
IN
Other
Enumeration date
10/04/2007
Last updated
10/04/2007
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