Healthcare Provider Details

I. General information

NPI: 1801132865
Provider Name (Legal Business Name): TAYLOR B CHESNEY PSY.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TAYLOR LUBITZ

II. Dates (important events)

Enumeration Date: 12/19/2012
Last Update Date: 09/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 HAMILTON AVE SUITE 329
PALO ALTO CA
94301-2010
US

IV. Provider business mailing address

207 CHARLES MARX WAY
PALO ALTO CA
94304-2426
US

V. Phone/Fax

Practice location:
  • Phone: 650-646-4698
  • Fax:
Mailing address:
  • Phone: 516-551-8063
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberPSY25953
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberPSB36963
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: