Healthcare Provider Details

I. General information

NPI: 1043405673
Provider Name (Legal Business Name): EMILY WING ZAVALA LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: EMILY RUSSELL WING

II. Dates (important events)

Enumeration Date: 09/06/2007
Last Update Date: 08/05/2022
Certification Date: 08/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

830 N CAPITOL AVE
SAN JOSE CA
95133-1316
US

IV. Provider business mailing address

830 N CAPITOL AVE
SAN JOSE CA
95133-1316
US

V. Phone/Fax

Practice location:
  • Phone: 408-347-5336
  • Fax: 408-347-5335
Mailing address:
  • Phone: 408-347-5336
  • Fax: 408-347-5335

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW64032
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: