Provider Demographics
NPI:1679759690
Name:CHIN, TING LAN (PHD)
Entity Type:Individual
Prefix:
First Name:TING
Middle Name:LAN
Last Name:CHIN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:LAN
Other - Middle Name:
Other - Last Name:CHIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:378 4TH ST
Mailing Address - Street 2:# 2
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-2902
Mailing Address - Country:US
Mailing Address - Phone:917-854-4968
Mailing Address - Fax:
Practice Address - Street 1:31 W 9TH ST
Practice Address - Street 2:GARDEN SUITE
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-9206
Practice Address - Country:US
Practice Address - Phone:917-854-4968
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-22
Last Update Date:2013-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0172931103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical