Provider Demographics
NPI:1700306172
Name:YU, CAROL CHU (PHD)
Entity Type:Individual
Prefix:DR
First Name:CAROL
Middle Name:CHU
Last Name:YU
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:CAROL
Other - Middle Name:
Other - Last Name:CHU
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:95 HYDE PARK AVE APT 515
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02130-5282
Mailing Address - Country:US
Mailing Address - Phone:215-439-3577
Mailing Address - Fax:
Practice Address - Street 1:1330 BEACON ST STE 324
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-3203
Practice Address - Country:US
Practice Address - Phone:215-439-3577
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-26
Last Update Date:2020-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MA11144103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program