Provider Demographics
NPI:1023301140
Name:CHEN, SU HSIU (MFT)
Entity type:Individual
Prefix:
First Name:SU
Middle Name:HSIU
Last Name:CHEN
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1475 DE ROSE WAY
Mailing Address - Street 2:256A
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95126-4147
Mailing Address - Country:US
Mailing Address - Phone:408-834-0684
Mailing Address - Fax:
Practice Address - Street 1:430 SHERMAN AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94306-1842
Practice Address - Country:US
Practice Address - Phone:408-834-0684
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-23
Last Update Date:2011-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC48708106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist