Provider Demographics
NPI:1043711823
Name:TANUVASA-STROTMAN, CHANTEL (ASW)
Entity Type:Individual
Prefix:
First Name:CHANTEL
Middle Name:
Last Name:TANUVASA-STROTMAN
Suffix:
Gender:F
Credentials:ASW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1209
Mailing Address - Street 2:
Mailing Address - City:SAN GABRIEL
Mailing Address - State:CA
Mailing Address - Zip Code:91778-1209
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:208 W WELLS ST
Practice Address - Street 2:
Practice Address - City:SAN GABRIEL
Practice Address - State:CA
Practice Address - Zip Code:91776-3228
Practice Address - Country:US
Practice Address - Phone:808-778-4874
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-26
Last Update Date:2022-11-14
Deactivation Date:2019-02-19
Deactivation Code:
Reactivation Date:2022-11-14
Provider Licenses
StateLicense IDTaxonomies
CA77966104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker