Provider Demographics
NPI:1801388913
Name:CHAN, CONSTANCE SING WAI (PHD)
Entity Type:Individual
Prefix:DR
First Name:CONSTANCE
Middle Name:SING WAI
Last Name:CHAN
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 1:211 ROCK HARBOR RD
Mailing Address - Street 2:
Mailing Address - City:ORLEANS
Mailing Address - State:MA
Mailing Address - Zip Code:02653-2308
Mailing Address - Country:US
Mailing Address - Phone:617-438-3480
Mailing Address - Fax:
Practice Address - Street 1:211 ROCK HARBOR RD
Practice Address - Street 2:
Practice Address - City:ORLEANS
Practice Address - State:MA
Practice Address - Zip Code:02653-2308
Practice Address - Country:US
Practice Address - Phone:617-438-3480
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-04
Last Update Date:2018-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3135103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical