MEDICARE: CARMEN CHACON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	27583	CA

General Provider Information

NPI Number	:	1962533612
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARMEN CHACON

Provider Business Mailing Address
First Line	:	PO BOX 1381
Second Line	:
City	:	SUN VALLEY
State	:	CA
Zip	:	91353-1381
Country	:	US
Telephone Number	:	818-679-5336
Fax Number	:

Provider Business Practice Location Address
First Line	:	515 COLUMBIA AVE STE 300
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90017-1209
Country	:	US
Telephone Number	:	213-553-9121
Fax Number	:	213-201-3395

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/07/2007
Last Update Date	:	11/19/2020

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Directions to “ CARMEN CHACON ” Practice Location

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