Provider Demographics
NPI:1629384557
Name:CHANG, ROBIN RAY-LONG (PHD)
Entity Type:Individual
Prefix:DR
First Name:ROBIN
Middle Name:RAY-LONG
Last Name:CHANG
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 1:4800 MEMORIAL DR
Mailing Address - Street 2:BLDG. 7, RM 1C107
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76711-1329
Mailing Address - Country:US
Mailing Address - Phone:254-297-3522
Mailing Address - Fax:254-297-3396
Practice Address - Street 1:4800 MEMORIAL DR
Practice Address - Street 2:BLDG. 7, RM 1C107
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76711-1329
Practice Address - Country:US
Practice Address - Phone:254-297-3522
Practice Address - Fax:254-297-3396
Is Sole Proprietor?:No
Enumeration Date:2010-08-30
Last Update Date:2010-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPSY - 1182103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI1182OtherHAWAII LICENSURE PSY - 1182