Provider Demographics
NPI:1265808133
Name:CHAVEZ-SKOCHINSKI, ANDREA (LSCW)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:CHAVEZ-SKOCHINSKI
Suffix:
Gender:F
Credentials:LSCW
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:
Other - Last Name:CHAVEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ASW
Mailing Address - Street 1:12450 VAN NUYS BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:PACOIMA
Mailing Address - State:CA
Mailing Address - Zip Code:91331-1392
Mailing Address - Country:US
Mailing Address - Phone:626-395-7100
Mailing Address - Fax:
Practice Address - Street 1:12510 VAN NUYS BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:PACOIMA
Practice Address - State:CA
Practice Address - Zip Code:91331-1338
Practice Address - Country:US
Practice Address - Phone:626-395-7100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-14
Last Update Date:2021-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW73865104100000X, 101YM0800X
CALSCW1017151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health