Provider Demographics
NPI:1134586860
Name:CHUBB, MARK JAMES (LCSW)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:JAMES
Last Name:CHUBB
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4771 HATFIELD WALKWAY
Mailing Address - Street 2:UNIT 4
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95124
Mailing Address - Country:US
Mailing Address - Phone:408-466-2020
Mailing Address - Fax:408-984-3455
Practice Address - Street 1:130 N. JACKSON AVE
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95116
Practice Address - Country:US
Practice Address - Phone:408-535-4652
Practice Address - Fax:408-984-3455
Is Sole Proprietor?:No
Enumeration Date:2016-01-26
Last Update Date:2025-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X, 171M00000X
CALCSW1080481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No171M00000XOther Service ProvidersCase Manager/Care Coordinator