Provider Demographics
NPI:1558495416
Name:WRIGHT, CHARMAINE ELIZABETH (PSYCH TECH)
Entity Type:Individual
Prefix:MRS
First Name:CHARMAINE
Middle Name:ELIZABETH
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:PSYCH TECH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3555 S BASCOM AVE APT 3
Mailing Address - Street 2:
Mailing Address - City:CAMPBELL
Mailing Address - State:CA
Mailing Address - Zip Code:95008-7027
Mailing Address - Country:US
Mailing Address - Phone:408-369-1946
Mailing Address - Fax:
Practice Address - Street 1:1075 E SANTA CLARA ST
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95116-2244
Practice Address - Country:US
Practice Address - Phone:408-299-6175
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 26589101YM0800X, 167G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered167G00000XNursing Service ProvidersLicensed Psychiatric Technician