Provider Demographics
NPI:1043405673
Name:ZAVALA, EMILY WING (LCSW)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:WING
Last Name:ZAVALA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:RUSSELL
Other - Last Name:WING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:830 N CAPITOL AVE
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95133-1316
Mailing Address - Country:US
Mailing Address - Phone:408-347-5336
Mailing Address - Fax:408-347-5335
Practice Address - Street 1:830 N CAPITOL AVE
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95133-1316
Practice Address - Country:US
Practice Address - Phone:408-347-5336
Practice Address - Fax:408-347-5335
Is Sole Proprietor?:No
Enumeration Date:2007-09-06
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW640321041C0700X
1041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical