Provider Demographics
NPI:1104601467
Name:BOREA-NORRIS, CHUCK SHAWN
Entity type:Individual
Prefix:
First Name:CHUCK
Middle Name:SHAWN
Last Name:BOREA-NORRIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:CHUCK
Other - Middle Name:SHAWN
Other - Last Name:BOREA-NORRIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:301 EXECUTIVE PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94134-3389
Mailing Address - Country:US
Mailing Address - Phone:805-561-0039
Mailing Address - Fax:
Practice Address - Street 1:301 EXECUTIVE PARK BLVD
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94134-3389
Practice Address - Country:US
Practice Address - Phone:805-561-0039
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-25
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)