Provider Demographics
NPI:1083228571
Name:CHAN, NGA YING (LMHC, R-DMT)
Entity type:Individual
Prefix:MRS
First Name:NGA YING
Middle Name:
Last Name:CHAN
Suffix:
Gender:F
Credentials:LMHC, R-DMT
Other - Prefix:
Other - First Name:ANGEL
Other - Middle Name:
Other - Last Name:CHAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMHC, R-DMT
Mailing Address - Street 1:43 OLIVER ST
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02145-4127
Mailing Address - Country:US
Mailing Address - Phone:617-230-7825
Mailing Address - Fax:
Practice Address - Street 1:43 OLIVER ST
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02145-4127
Practice Address - Country:US
Practice Address - Phone:617-230-7825
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-02
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10001282101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health