Provider Demographics
NPI:1700917747
Name:CHAN, JANE YIP (PHD)
Entity Type:Individual
Prefix:DR
First Name:JANE
Middle Name:YIP
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 1:19 STRAWBERRY LN
Mailing Address - Street 2:
Mailing Address - City:ROSLYN HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11577-2531
Mailing Address - Country:US
Mailing Address - Phone:516-621-1477
Mailing Address - Fax:
Practice Address - Street 1:19 STRAWBERRY LN
Practice Address - Street 2:
Practice Address - City:ROSLYN HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11577-2531
Practice Address - Country:US
Practice Address - Phone:516-621-1477
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011368-1103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist