Provider Demographics
NPI:1437353737
Name:CHACON, VERCILA E (LCSW)
Entity Type:Individual
Prefix:MS
First Name:VERCILA
Middle Name:E
Last Name:CHACON
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 1:370 S KING RD
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95116-3400
Mailing Address - Country:US
Mailing Address - Phone:408-318-2817
Mailing Address - Fax:408-251-6987
Practice Address - Street 1:370 S KING RD
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95116-3400
Practice Address - Country:US
Practice Address - Phone:408-318-2817
Practice Address - Fax:408-251-6987
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-12
Last Update Date:2009-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS178411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical