Provider Demographics
NPI:1851943336
Name:MALABANAN, CHANTELLE THERESE (MSW, ACSW)
Entity Type:Individual
Prefix:
First Name:CHANTELLE
Middle Name:THERESE
Last Name:MALABANAN
Suffix:
Gender:F
Credentials:MSW, ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22471 ASPAN ST STE 103
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:CA
Mailing Address - Zip Code:92630-1644
Mailing Address - Country:US
Mailing Address - Phone:949-458-2715
Mailing Address - Fax:949-458-3583
Practice Address - Street 1:22471 ASPAN ST STE 103
Practice Address - Street 2:
Practice Address - City:LAKE FOREST
Practice Address - State:CA
Practice Address - Zip Code:92630-1644
Practice Address - Country:US
Practice Address - Phone:949-458-2715
Practice Address - Fax:949-458-3583
Is Sole Proprietor?:No
Enumeration Date:2019-07-15
Last Update Date:2022-05-24
Deactivation Date:2020-09-21
Deactivation Code:
Reactivation Date:2020-11-05
Provider Licenses
StateLicense IDTaxonomies
CA960901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical