Denise Kathen Tan Agatep, LCSW
Individual provider Active NPI Counselor · Fremont, CA
NPI 1164584900 · NPPES record last updated Jan 11, 2022
Key facts
- NPI
- 1164584900
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Counselor 101Y00000X
- Practice address
- 39400 Paseo Padre Pkwy
Niles West BLDG, 3Rd FLR
Fremont, CA 94538-2310 - Phone
- (510) 248-3283
- Fax
- (510) 248-3551
- NPI assigned
- Dec 15, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: No · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20110613000238 | CA | Practitioner - Clinical Social Worker | 9133306509 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 27117 | CA | MD | Clinical Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Permanente Medical Group Inc | Current |
Accepting new patients |
Locations
39400 Paseo Padre Pkwy
Fremont, CA 94538
Phone (510) 248-3000
39400 Paseo Padre Pkwy
Bldg 3RD
Fremont, CA 94538
Phone (510) 248-3283
3825 Hopyard Rd
Ste 140
Pleasanton, CA 94588
Phone (925) 847-5051
1150 Veterans Blvd
Redwood City, CA 94063
Phone (650) 299-2015
901 Nevin Ave
Richmond, CA 94801
Phone (510) 307-1500
501 J St
Sacramento, CA 95814
Phone (916) 497-3000
2200 Ofarrell St
San Francisco, CA 94115
Phone (415) 202-2000
710 Lawrence Expy
Santa Clara, CA 95051
Phone (408) 236-6400
5615 Scotts Valley Dr
Scotts Valley, CA 95066
Phone (831) 430-2700
7373 West Ln
Stockton, CA 95210
Phone (209) 476-2000
975 Sereno Dr
Vallejo, CA 94589
Phone (707) 651-1000
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | Yes |
Addresses
Primary practice location
39400 Paseo Padre Pkwy
Niles West BLDG, 3Rd FLR
Fremont, CA 94538-2310
Mailing address
39400 Paseo Padre Pkwy
Niles West BLDG, 3Rd FLR
Fremont, CA 94538-2310
Phone (510) 248-3283
Other names
- Denise Kathen Tan
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| SOAP URL | https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ncalceq | Health Information Exchange (HIE) | The Permanente Medical Group |
Other providers in Fremont, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 11, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.