Provider Demographics
NPI:1881716330
Name:NGUYEN, PHUOC VAN (MSW)
Entity type:Individual
Prefix:MR
First Name:PHUOC
Middle Name:VAN
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4410 N. PERSHING AVE. C1
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95207
Mailing Address - Country:US
Mailing Address - Phone:209-815-8298
Mailing Address - Fax:209-953-8478
Practice Address - Street 1:4410 N. PERSHING AVE. C1
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207
Practice Address - Country:US
Practice Address - Phone:209-323-5338
Practice Address - Fax:209-953-8478
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2022-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical