Provider Demographics
NPI:1134816952
Name:CHEN, CHRISTINE CHIA-JANE (MA)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:CHIA-JANE
Last Name:CHEN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36343 TUNBRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:CA
Mailing Address - Zip Code:94560-2056
Mailing Address - Country:US
Mailing Address - Phone:510-304-2854
Mailing Address - Fax:
Practice Address - Street 1:3100 MOWRY AVE STE 303
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-1531
Practice Address - Country:US
Practice Address - Phone:510-794-8581
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-21
Last Update Date:2024-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT145790106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist