Provider Demographics
NPI:1275765521
Name:CHEN, NANCY (MA)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:CHEN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 PACIFIC AVENUE APT. A
Mailing Address - Street 2:
Mailing Address - City:ALAMEDA
Mailing Address - State:CA
Mailing Address - Zip Code:94501-2200
Mailing Address - Country:US
Mailing Address - Phone:510-316-5170
Mailing Address - Fax:
Practice Address - Street 1:300 PACIFIC AVE APT A
Practice Address - Street 2:
Practice Address - City:ALAMEDA
Practice Address - State:CA
Practice Address - Zip Code:94501-1856
Practice Address - Country:US
Practice Address - Phone:510-316-5170
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY28077103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist