Provider Demographics
NPI:1932469947
Name:CHAN, STEPHANY
Entity Type:Individual
Prefix:
First Name:STEPHANY
Middle Name:
Last Name:CHAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10901 MACARTHUR BLVD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94605-5200
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10901 MACARTHUR BLVD
Practice Address - Street 2:SUITE 202
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94605-5200
Practice Address - Country:US
Practice Address - Phone:510-430-1115
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-23
Last Update Date:2012-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA70080101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health