Provider Demographics
NPI:1336478189
Name:PSYCHOLOGICAL WELLNESS AND SUPPORT, PLLC
Entity Type:Organization
Organization Name:PSYCHOLOGICAL WELLNESS AND SUPPORT, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JANE
Authorized Official - Middle Name:YIP
Authorized Official - Last Name:CHAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:516-375-7802
Mailing Address - Street 1:185 ROSLYN RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:ROSLYN HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11577-1356
Mailing Address - Country:US
Mailing Address - Phone:516-375-7802
Mailing Address - Fax:
Practice Address - Street 1:19 STRAWBERRY LN
Practice Address - Street 2:
Practice Address - City:ROSLYN HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11577-2531
Practice Address - Country:US
Practice Address - Phone:516-375-7802
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-08
Last Update Date:2009-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011368103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty