Healthcare Provider Details

I. General information

NPI: 1356545008
Provider Name (Legal Business Name): MICHELLE CHAU LY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. MICHELLE CHAU NGUYEN

II. Dates (important events)

Enumeration Date: 06/14/2007
Last Update Date: 08/18/2023
Certification Date: 08/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

652 FOREST AVE
PALO ALTO CA
94301-2622
US

IV. Provider business mailing address

1922 THE ALAMEDA STE 316
SAN JOSE CA
95126-1461
US

V. Phone/Fax

Practice location:
  • Phone: 650-484-1493
  • Fax: 650-323-1720
Mailing address:
  • Phone: 408-261-7777
  • Fax: 408-642-6052

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW68047
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: