Provider Demographics
NPI:1598147225
Name:CHOU, TINA (PHD)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:
Last Name:CHOU
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 WARE RD
Mailing Address - Street 2:
Mailing Address - City:AUBURNDALE
Mailing Address - State:MA
Mailing Address - Zip Code:02466-1416
Mailing Address - Country:US
Mailing Address - Phone:617-953-4296
Mailing Address - Fax:
Practice Address - Street 1:12 WARE RD
Practice Address - Street 2:
Practice Address - City:AUBURNDALE
Practice Address - State:MA
Practice Address - Zip Code:02466-1416
Practice Address - Country:US
Practice Address - Phone:617-862-4086
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-18
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA11206103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist