Provider Demographics
NPI:1043352156
Name:CHIN, MARY P
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:P
Last Name:CHIN
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 1:1650 SIERRA AVE
Mailing Address - Street 2:SUITE 106
Mailing Address - City:YUBA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95993-8986
Mailing Address - Country:US
Mailing Address - Phone:530-751-1925
Mailing Address - Fax:
Practice Address - Street 1:1650 SIERRA AVE
Practice Address - Street 2:SUITE 106
Practice Address - City:YUBA CITY
Practice Address - State:CA
Practice Address - Zip Code:95993-8986
Practice Address - Country:US
Practice Address - Phone:530-751-1925
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS82051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical