Provider Demographics
NPI:1740573237
Name:CHANG, PEGGY YI SHAN (LCSW)
Entity Type:Individual
Prefix:
First Name:PEGGY
Middle Name:YI SHAN
Last Name:CHANG
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:YI SHAN
Other - Middle Name:
Other - Last Name:CHANG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:106 E SANTONA CT
Mailing Address - Street 2:
Mailing Address - City:LA HABRA
Mailing Address - State:CA
Mailing Address - Zip Code:90631-9261
Mailing Address - Country:US
Mailing Address - Phone:909-569-3841
Mailing Address - Fax:
Practice Address - Street 1:18623 GALE AVE
Practice Address - Street 2:
Practice Address - City:CITY OF INDUSTRY
Practice Address - State:CA
Practice Address - Zip Code:91748-1342
Practice Address - Country:US
Practice Address - Phone:626-839-0300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-17
Last Update Date:2018-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA855131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical