Healthcare Provider Details

I. General information

NPI: 1376674036
Provider Name (Legal Business Name): SHARON CHEN PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 08/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

595 E COLORADO BLVD
PASADENA CA
91101-2039
US

IV. Provider business mailing address

PO BOX 65
PASADENA CA
91102-0065
US

V. Phone/Fax

Practice location:
  • Phone: 626-298-8068
  • Fax:
Mailing address:
  • Phone: 626-298-8068
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY21946
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: