Provider Demographics
NPI:1063488286
Name:CHANG, DAPHNE LIN (LPC)
Entity Type:Individual
Prefix:MS
First Name:DAPHNE
Middle Name:LIN
Last Name:CHANG
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 SHAWNEE TRL
Mailing Address - Street 2:
Mailing Address - City:MONTVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07045-9740
Mailing Address - Country:US
Mailing Address - Phone:973-541-9157
Mailing Address - Fax:
Practice Address - Street 1:800 CATALPA AVE
Practice Address - Street 2:
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-1828
Practice Address - Country:US
Practice Address - Phone:973-541-9157
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00294200101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional