Provider Demographics
NPI:1427884139
Name:CHEN, CRYSTAL JING (PHD)
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:JING
Last Name:CHEN
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 1:200 RIVERSIDE BLVD APT 44B
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10069-0917
Mailing Address - Country:US
Mailing Address - Phone:646-468-3143
Mailing Address - Fax:
Practice Address - Street 1:501 5TH AVE RM 1108
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-7880
Practice Address - Country:US
Practice Address - Phone:212-271-0216
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-10
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral