Provider Demographics
NPI:1063623569
Name:CHAN, PHILIE KATHERINE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:PHILIE
Middle Name:KATHERINE
Last Name:CHAN
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 1:1511 NAGLEE AVE
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95126-2012
Mailing Address - Country:US
Mailing Address - Phone:408-295-8407
Mailing Address - Fax:
Practice Address - Street 1:39155 LIBERTY ST STE G710
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-1525
Practice Address - Country:US
Practice Address - Phone:510-795-2434
Practice Address - Fax:510-793-3972
Is Sole Proprietor?:No
Enumeration Date:2007-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA192551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical