Provider Demographics
NPI:1992844948
Name:MAO, SAMPHORS THONG (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:SAMPHORS
Middle Name:THONG
Last Name:MAO
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 1:1650 LAS PLUMAS AVE STE K
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95133-1657
Mailing Address - Country:US
Mailing Address - Phone:408-272-6726
Mailing Address - Fax:408-259-0865
Practice Address - Street 1:1650 LAS PLUMAS AVE STE K
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95133-1657
Practice Address - Country:US
Practice Address - Phone:408-272-6727
Practice Address - Fax:408-259-0865
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2021-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 229841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical