Doctor Name: | MRS. KATHLEEN ANN CHAN |
NPI Number: | 1104056613 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LCSW |
License Number: | LCSW-3864 |
Business Practice Address: | 4577 W Pecos Rd Laveen, AZ - 85339 |
Business Phone Number: | 5205506041 |
Business Fax Number: | 5205506033 |
Mailing Address: | 4577 W Pecos Rd, LAVEEN |
State: | AZ |
Postal Code: | 85339 |
Phone Number: | 5205506041 |
Fax Number: | 5205506033 |
NPI Enumeration Date: | 07/17/2009 |
NPI Last Update Date: | 07/17/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | LCSW-3864 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | AZ |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Social Worker |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: | A social worker who holds a master |