Provider Demographics
NPI:1114206729
Name:LE, THANH PHUONG (LCSW)
Entity Type:Individual
Prefix:MISS
First Name:THANH
Middle Name:PHUONG
Last Name:LE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1136 GASSETT CT
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94544-5753
Mailing Address - Country:US
Mailing Address - Phone:510-309-0417
Mailing Address - Fax:
Practice Address - Street 1:2401 MERCED ST
Practice Address - Street 2:
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94577-4228
Practice Address - Country:US
Practice Address - Phone:510-618-5969
Practice Address - Fax:510-618-5830
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-12
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CA873071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program