Provider Demographics
NPI:1003011230
Name:CHEN, EMILY P (PHD)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:P
Last Name:CHEN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 E AMERIGE AVE STE 228
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92832-1920
Mailing Address - Country:US
Mailing Address - Phone:562-231-6733
Mailing Address - Fax:
Practice Address - Street 1:2601 AIRPORT DR STE 135
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-6141
Practice Address - Country:US
Practice Address - Phone:424-201-1600
Practice Address - Fax:424-201-1601
Is Sole Proprietor?:No
Enumeration Date:2007-06-18
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY30252103TC2200X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
1184477093OtherNPI-2 ORGANIZATION