Provider Demographics
NPI:1043462674
Name:EVANGELISTA, CHIARRA FERRER (LCSW)
Entity type:Individual
Prefix:
First Name:CHIARRA
Middle Name:FERRER
Last Name:EVANGELISTA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:CHIARRA
Other - Middle Name:
Other - Last Name:FERRER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:161 WINDSHADOW CT
Mailing Address - Street 2:
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94591-7767
Mailing Address - Country:US
Mailing Address - Phone:707-334-2694
Mailing Address - Fax:
Practice Address - Street 1:975 SERENO DR
Practice Address - Street 2:
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94589-2441
Practice Address - Country:US
Practice Address - Phone:707-651-1000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-14
Last Update Date:2015-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA295861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical