Provider Demographics
NPI:1235457169
Name:CHAN, MELVIN J (LMSW)
Entity Type:Individual
Prefix:MR
First Name:MELVIN
Middle Name:J
Last Name:CHAN
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 THISTLE LN
Mailing Address - Street 2:
Mailing Address - City:WILTON
Mailing Address - State:CT
Mailing Address - Zip Code:06897-4125
Mailing Address - Country:US
Mailing Address - Phone:203-246-6497
Mailing Address - Fax:
Practice Address - Street 1:210 JORALEMON ST
Practice Address - Street 2:3RD FLOOR
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-3743
Practice Address - Country:US
Practice Address - Phone:718-250-5557
Practice Address - Fax:718-250-4757
Is Sole Proprietor?:No
Enumeration Date:2010-05-17
Last Update Date:2010-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY080210104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker