Provider Demographics
NPI:1568672236
Name:WANG, NAITIAN (PHD)
Entity Type:Individual
Prefix:
First Name:NAITIAN
Middle Name:
Last Name:WANG
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 HASTINGS DR
Mailing Address - Street 2:
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11790-2312
Mailing Address - Country:US
Mailing Address - Phone:315-278-4973
Mailing Address - Fax:
Practice Address - Street 1:UNIVERSITY COUNSELING CTR
Practice Address - Street 2:STADIUM ROAD
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11794-3100
Practice Address - Country:US
Practice Address - Phone:631-632-4190
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2009-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016454103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist