Provider Demographics
NPI:1366578973
Name:CHAPA, PATRICIA MEDINA (LCSW)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:MEDINA
Last Name:CHAPA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:
Other - Last Name:MEDINA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:DALE ROAD MEDICAL OFFICES
Mailing Address - Street 2:3800 DALE ROAD, 2ND FLOOR
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95356
Mailing Address - Country:US
Mailing Address - Phone:209-557-6500
Mailing Address - Fax:
Practice Address - Street 1:DALE ROAD MEDICAL OFFICES
Practice Address - Street 2:3800 DALE ROAD, 2ND FLOOR
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95356
Practice Address - Country:US
Practice Address - Phone:209-557-6500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2022-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW235191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical