Provider Demographics
NPI:1225238678
Name:NGUYEN, NGA THU (LCSW)
Entity Type:Individual
Prefix:
First Name:NGA
Middle Name:THU
Last Name:NGUYEN
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 1:1887 MONTEREY HWY STE 205
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95112-6192
Mailing Address - Country:US
Mailing Address - Phone:408-494-1561
Mailing Address - Fax:
Practice Address - Street 1:1887 MONTEREY HWY STE 205
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95112-6192
Practice Address - Country:US
Practice Address - Phone:408-494-1561
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-24
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS279231041C0700X
CA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHE525TMedicare PIN
CAHE525RMedicare PIN
CAHE525YMedicare PIN
CAHE525VMedicare PIN
CAHE525SMedicare PIN
CAHE525UMedicare PIN
CAHE525WMedicare PIN
CAHE525XMedicare PIN
CAHE525ZMedicare PIN