Provider Demographics
NPI:1811193261
Name:WESTPHAL CHIARAMONTE, GWEN COLLEEN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:GWEN
Middle Name:COLLEEN
Last Name:WESTPHAL CHIARAMONTE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:GWEN
Other - Middle Name:COLLEEN
Other - Last Name:WESTPHAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:10065 E ZAYANTE RD
Mailing Address - Street 2:
Mailing Address - City:FELTON
Mailing Address - State:CA
Mailing Address - Zip Code:95018-9032
Mailing Address - Country:US
Mailing Address - Phone:831-335-7593
Mailing Address - Fax:408-975-5561
Practice Address - Street 1:10065 E ZAYANTE RD
Practice Address - Street 2:
Practice Address - City:FELTON
Practice Address - State:CA
Practice Address - Zip Code:95018-9032
Practice Address - Country:US
Practice Address - Phone:408-975-5766
Practice Address - Fax:408-975-5561
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS109371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical