Provider Demographics
NPI:1326495003
Name:STRONG-CHAVEZ, TAMARA
Entity type:Individual
Prefix:
First Name:TAMARA
Middle Name:
Last Name:STRONG-CHAVEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1118 MERIDIAN AVE STE 150
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95125-4352
Mailing Address - Country:US
Mailing Address - Phone:408-445-8172
Mailing Address - Fax:
Practice Address - Street 1:1118 MERIDIAN AVE STE 150
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95125-4352
Practice Address - Country:US
Practice Address - Phone:408-445-8172
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-23
Last Update Date:2025-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CA34171103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program