Provider Demographics
NPI:1477764959
Name:CHANG, CHARLES L (MSW)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:L
Last Name:CHANG
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1750 E OCEAN BLVD
Mailing Address - Street 2:602
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90802-6060
Mailing Address - Country:US
Mailing Address - Phone:562-432-4174
Mailing Address - Fax:
Practice Address - Street 1:1750 E OCEAN BLVD
Practice Address - Street 2:602
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90802-6060
Practice Address - Country:US
Practice Address - Phone:562-432-4174
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 39041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical