Provider Demographics
NPI:1700537701
Name:PARK-CHAN, JANICE (LCSW)
Entity Type:Individual
Prefix:
First Name:JANICE
Middle Name:
Last Name:PARK-CHAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21271 26TH AVE UNIT 604530
Mailing Address - Street 2:
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11360-1956
Mailing Address - Country:US
Mailing Address - Phone:929-269-2464
Mailing Address - Fax:
Practice Address - Street 1:20807 33RD AVE
Practice Address - Street 2:
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11361-1314
Practice Address - Country:US
Practice Address - Phone:929-218-2779
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-12
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0925021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical