Provider Demographics
NPI:1376946186
Name:NGUYEN, JAMIE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:JAMIE
Middle Name:
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 1:51 E CAMPBELL AVE STE 106C
Mailing Address - Street 2:
Mailing Address - City:CAMPBELL
Mailing Address - State:CA
Mailing Address - Zip Code:95008-2054
Mailing Address - Country:US
Mailing Address - Phone:408-703-6720
Mailing Address - Fax:
Practice Address - Street 1:51 E CAMPBELL AVE STE 106C
Practice Address - Street 2:
Practice Address - City:CAMPBELL
Practice Address - State:CA
Practice Address - Zip Code:95008-2054
Practice Address - Country:US
Practice Address - Phone:408-703-6720
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-07
Last Update Date:2015-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 248511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical