Provider Demographics
NPI:1134586860
Name:CHUBB, MARK (MSW)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:CHUBB
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1250 S WINCHESTER BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-3906
Mailing Address - Country:US
Mailing Address - Phone:408-241-3844
Mailing Address - Fax:408-984-3455
Practice Address - Street 1:1250 S WINCHESTER BLVD
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128
Practice Address - Country:US
Practice Address - Phone:408-241-3844
Practice Address - Fax:408-984-3455
Is Sole Proprietor?:No
Enumeration Date:2016-01-26
Last Update Date:2018-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No171M00000XOther Service ProvidersCase Manager/Care Coordinator