Provider Demographics
NPI:1861687832
Name:PACKER, JOAN (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:JOAN
Middle Name:
Last Name:PACKER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:184 DOUGLANE AVE
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95117-1019
Mailing Address - Country:US
Mailing Address - Phone:408-248-8173
Mailing Address - Fax:408-248-4127
Practice Address - Street 1:184 DOUGLANE AVE
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95117-1019
Practice Address - Country:US
Practice Address - Phone:408-248-8173
Practice Address - Fax:408-248-4127
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-12
Last Update Date:2007-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS140051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical