Basic Information
| Provider Information | |||||||||
| NPI: | 1043576895 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KINCHEN | ||||||||
| FirstName: | CHRYS | ||||||||
| MiddleName: | VIOLET | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | MSW, LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1130 S FLOWER ST | ||||||||
| Address2: | UNIT #205 | ||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900152139 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2137429881 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3751 STOCKER ST | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900085101 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3232983680 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/05/2012 | ||||||||
| LastUpdateDate: | 06/10/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | N | Behavioral Health & Social Service Providers | Social Worker | 1041C0700X | 29221 | CA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.