Provider Demographics
NPI:1740336841
Name:GAO, YUAN (PHD)
Entity type:Individual
Prefix:
First Name:YUAN
Middle Name:
Last Name:GAO
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 1:3 PHEASANT RUN LN
Mailing Address - Street 2:
Mailing Address - City:DIX HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11746-8143
Mailing Address - Country:US
Mailing Address - Phone:516-596-0527
Mailing Address - Fax:631-254-1222
Practice Address - Street 1:3 PHEASANT RUN LN
Practice Address - Street 2:
Practice Address - City:DIX HILLS
Practice Address - State:NY
Practice Address - Zip Code:11746-8143
Practice Address - Country:US
Practice Address - Phone:516-596-0527
Practice Address - Fax:631-254-1222
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013365103TC0700X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical