Healthcare Provider Details

I. General information

NPI: 1043462674
Provider Name (Legal Business Name): CHIARRA FERRER EVANGELISTA LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CHIARRA FERRER

II. Dates (important events)

Enumeration Date: 10/14/2008
Last Update Date: 06/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

975 SERENO DR
VALLEJO CA
94589-2441
US

IV. Provider business mailing address

161 WINDSHADOW CT
VALLEJO CA
94591-7767
US

V. Phone/Fax

Practice location:
  • Phone: 707-651-1000
  • Fax:
Mailing address:
  • Phone: 707-334-2694
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number29586
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: