Provider Demographics
NPI:1699752196
Name:CHANG, BARBARA (PHD)
Entity type:Individual
Prefix:
First Name:BARBARA
Middle Name:
Last Name:CHANG
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:BARBARA
Other - Middle Name:
Other - Last Name:BAUCLT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:55 BETHUNE ST
Mailing Address - Street 2:C616
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10014
Mailing Address - Country:US
Mailing Address - Phone:212-741-0897
Mailing Address - Fax:
Practice Address - Street 1:1776 BROADWAY
Practice Address - Street 2:RM 1704
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019
Practice Address - Country:US
Practice Address - Phone:212-757-6620
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY4941103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00921619Medicaid
NYV30131Medicare ID - Type Unspecified