Provider Demographics
NPI:1366697211
Name:CHEZEM, VANESSA LYNN (PSYCHIATRIC TECHNIAN)
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:LYNN
Last Name:CHEZEM
Suffix:
Gender:F
Credentials:PSYCHIATRIC TECHNIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10025 OLD MORRO RD E
Mailing Address - Street 2:
Mailing Address - City:ATASCADERO
Mailing Address - State:CA
Mailing Address - Zip Code:93422-4921
Mailing Address - Country:US
Mailing Address - Phone:805-466-0219
Mailing Address - Fax:
Practice Address - Street 1:10025 OLD MORRO RD E
Practice Address - Street 2:
Practice Address - City:ATASCADERO
Practice Address - State:CA
Practice Address - Zip Code:93422-4921
Practice Address - Country:US
Practice Address - Phone:805-466-0219
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-19
Last Update Date:2008-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31308101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health