Provider Demographics
NPI:1205038189
Name:CANGER, CHARLENE
Entity Type:Individual
Prefix:
First Name:CHARLENE
Middle Name:
Last Name:CANGER
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 1:1050 BROADWAY CT
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95125-2200
Mailing Address - Country:US
Mailing Address - Phone:408-286-9682
Mailing Address - Fax:650-723-2829
Practice Address - Street 1:1885 THE ALAMEDA
Practice Address - Street 2:SUITE 100K
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95126-1744
Practice Address - Country:US
Practice Address - Phone:408-241-8140
Practice Address - Fax:650-723-2829
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS85911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA106H00000XOtherMARRIAGE & FAMILY
CA1041C0700XOtherCLINICAL SOCIAL WORKER