Provider Demographics
NPI:1033261367
Name:CHEN, CAROL Y (MA)
Entity Type:Individual
Prefix:MISS
First Name:CAROL
Middle Name:Y
Last Name:CHEN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MISS
Other - First Name:YUN-CHU
Other - Middle Name:
Other - Last Name:CHEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA
Mailing Address - Street 1:13603 MARINA POINTE DR
Mailing Address - Street 2:C537
Mailing Address - City:MARINA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90292-5583
Mailing Address - Country:US
Mailing Address - Phone:310-306-9889
Mailing Address - Fax:
Practice Address - Street 1:240 E. 20TH ST
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806
Practice Address - Country:US
Practice Address - Phone:562-599-9271
Practice Address - Fax:562-218-4076
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical