Provider Demographics
NPI:1013673961
Name:CHAN, KALIE ELLEN
Entity Type:Individual
Prefix:
First Name:KALIE
Middle Name:ELLEN
Last Name:CHAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:235 W 63RD ST APT 6F
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-6806
Mailing Address - Country:US
Mailing Address - Phone:650-722-6263
Mailing Address - Fax:
Practice Address - Street 1:6 MARTHA RD
Practice Address - Street 2:
Practice Address - City:MONSEY
Practice Address - State:NY
Practice Address - Zip Code:10952-1406
Practice Address - Country:US
Practice Address - Phone:845-327-7111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-15
Last Update Date:2021-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst