Provider Demographics
NPI:1801132865
Name:CHESNEY, TAYLOR B (PSYD)
Entity type:Individual
Prefix:DR
First Name:TAYLOR
Middle Name:B
Last Name:CHESNEY
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:TAYLOR
Other - Middle Name:
Other - Last Name:LUBITZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:207 CHARLES MARX WAY
Mailing Address - Street 2:
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94304-2426
Mailing Address - Country:US
Mailing Address - Phone:516-551-8063
Mailing Address - Fax:
Practice Address - Street 1:550 HAMILTON AVE
Practice Address - Street 2:SUITE 329
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94301-2010
Practice Address - Country:US
Practice Address - Phone:650-646-4698
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-19
Last Update Date:2013-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSB36963390200000X
CAPSY25953103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent