Provider Demographics
NPI:1881436111
Name:WILLIAMS-PATTERSON, CHANTAL TAMARA
Entity type:Individual
Prefix:
First Name:CHANTAL
Middle Name:TAMARA
Last Name:WILLIAMS-PATTERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CHANTAL
Other - Middle Name:
Other - Last Name:PATTERSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:822 VICEROY WAY
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95133-1430
Mailing Address - Country:US
Mailing Address - Phone:408-648-3547
Mailing Address - Fax:
Practice Address - Street 1:1132 MCKENDRIE ST
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95126-1406
Practice Address - Country:US
Practice Address - Phone:408-292-4357
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-07
Last Update Date:2024-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician