Provider Demographics
NPI:1447815055
Name:WONG, CHELSEA (LCSW)
Entity type:Individual
Prefix:
First Name:CHELSEA
Middle Name:
Last Name:WONG
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3277 S WHITE RD
Mailing Address - Street 2:PMB 6059
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95148-4056
Mailing Address - Country:US
Mailing Address - Phone:408-454-8075
Mailing Address - Fax:
Practice Address - Street 1:3277 S WHITE RD
Practice Address - Street 2:PMB 6059
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95148-4056
Practice Address - Country:US
Practice Address - Phone:408-454-8075
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-08
Last Update Date:2024-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA117403104100000X
CA95480101YM0800X, 104100000X
390200000X
CAASW95480104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program