Provider Demographics
NPI:1548607534
Name:FAN, YIWEN (LMHC)
Entity Type:Individual
Prefix:
First Name:YIWEN
Middle Name:
Last Name:FAN
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:YIMIN
Other - Middle Name:
Other - Last Name:FAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:352 7TH AVE
Mailing Address - Street 2:SUITE 705
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001
Mailing Address - Country:US
Mailing Address - Phone:917-683-1107
Mailing Address - Fax:
Practice Address - Street 1:352 7TH AVE
Practice Address - Street 2:SUITE 705
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001
Practice Address - Country:US
Practice Address - Phone:860-469-5963
Practice Address - Fax:718-358-5265
Is Sole Proprietor?:No
Enumeration Date:2013-05-30
Last Update Date:2018-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health