Provider Demographics
NPI:1063608487
Name:CHEN, PHYLLIS W (PSY D)
Entity type:Individual
Prefix:
First Name:PHYLLIS
Middle Name:W
Last Name:CHEN
Suffix:
Gender:F
Credentials:PSY D
Other - Prefix:DR
Other - First Name:PHYLLIS
Other - Middle Name:W
Other - Last Name:CHEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSY D
Mailing Address - Street 1:3626 BALBOA ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94121-2604
Mailing Address - Country:US
Mailing Address - Phone:415-668-5955
Mailing Address - Fax:415-668-0246
Practice Address - Street 1:3626 BALBOA ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94121-2604
Practice Address - Country:US
Practice Address - Phone:415-668-5955
Practice Address - Fax:415-668-0246
Is Sole Proprietor?:No
Enumeration Date:2007-09-19
Last Update Date:2010-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health