Healthcare Provider Details

I. General information

NPI: 1104108489
Provider Name (Legal Business Name): MARIA CHUA LCSW, MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/13/2011
Last Update Date: 09/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6651 BALBOA BLVD
VAN NUYS CA
91406-5529
US

IV. Provider business mailing address

1444 WINCHESTER AVE
GLENDALE CA
91201-1218
US

V. Phone/Fax

Practice location:
  • Phone: 818-758-2300
  • Fax:
Mailing address:
  • Phone: 818-265-9468
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS19464
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: