Provider Demographics
NPI:1134743651
Name:TANG, LIN (PHD)
Entity type:Individual
Prefix:DR
First Name:LIN
Middle Name:
Last Name:TANG
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 1:60 ROLLING RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:MA
Mailing Address - Zip Code:01002-1419
Mailing Address - Country:US
Mailing Address - Phone:914-522-2659
Mailing Address - Fax:
Practice Address - Street 1:60 ROLLING RIDGE RD
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:MA
Practice Address - Zip Code:01002-1419
Practice Address - Country:US
Practice Address - Phone:914-522-2659
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-01
Last Update Date:2020-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA11082-PY-PR103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchoolGroup - Single Specialty