Provider Demographics
NPI:1750614236
Name:CHAICHANA, TIPADA (LCSW)
Entity type:Individual
Prefix:
First Name:TIPADA
Middle Name:
Last Name:CHAICHANA
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 1:200 MUIR ROAD
Mailing Address - Street 2:HACIENDA BUILDING TRANSITIONS PROGRAM
Mailing Address - City:MARTINEZ
Mailing Address - State:CA
Mailing Address - Zip Code:94553
Mailing Address - Country:US
Mailing Address - Phone:925-372-1274
Mailing Address - Fax:
Practice Address - Street 1:200 MUIR ROAD
Practice Address - Street 2:HACIENDA BUILDING TRANSITIONS PROGRAM
Practice Address - City:MARTINEZ
Practice Address - State:CA
Practice Address - Zip Code:94553
Practice Address - Country:US
Practice Address - Phone:925-372-1274
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-15
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool