1811193261 NPI number — MS. GWEN COLLEEN WESTPHAL CHIARAMONTE LCSW

Table of content: MS. GWEN COLLEEN WESTPHAL CHIARAMONTE LCSW (NPI 1811193261)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811193261 NPI number — MS. GWEN COLLEEN WESTPHAL CHIARAMONTE LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WESTPHAL CHIARAMONTE
Provider First Name:
GWEN
Provider Middle Name:
COLLEEN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WESTPHAL
Provider Other First Name:
GWEN
Provider Other Middle Name:
COLLEEN
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LCSW
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1811193261
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10065 E ZAYANTE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FELTON
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95018-9032
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
831-335-7593
Provider Business Mailing Address Fax Number:
408-975-5561

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10065 E ZAYANTE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FELTON
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95018-9032
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
408-975-5766
Provider Business Practice Location Address Fax Number:
408-975-5561
Provider Enumeration Date:
06/22/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  LCS10937 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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