Provider Demographics
NPI:1083814164
Name:CHAN, TANIA S (MSW, LCSW)
Entity Type:Individual
Prefix:MRS
First Name:TANIA
Middle Name:S
Last Name:CHAN
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:MRS
Other - First Name:TANIA
Other - Middle Name:CSM
Other - Last Name:CHAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSW, LCSW
Mailing Address - Street 1:2000 ALAMEDA DE LAS PULGAS
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94403-1269
Mailing Address - Country:US
Mailing Address - Phone:650-372-8527
Mailing Address - Fax:650-341-7389
Practice Address - Street 1:2000 ALAMEDA DE LAS PULGAS
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94403-1269
Practice Address - Country:US
Practice Address - Phone:650-372-8527
Practice Address - Fax:650-341-7389
Is Sole Proprietor?:No
Enumeration Date:2007-07-18
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW606491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical