Provider Demographics
NPI:1801105283
Name:CHAN, YUEN SHAN MANNA (LCSW)
Entity type:Individual
Prefix:
First Name:YUEN SHAN
Middle Name:MANNA
Last Name: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 1:2 UNIVERSITY PLZ STE 100
Mailing Address - Street 2:
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-6210
Mailing Address - Country:US
Mailing Address - Phone:908-605-0542
Mailing Address - Fax:917-383-3378
Practice Address - Street 1:2 UNIVERSITY PLZ STE 100
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-6210
Practice Address - Country:US
Practice Address - Phone:908-605-0542
Practice Address - Fax:917-383-3378
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-01
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0697631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03275945Medicaid