Individual
EVANGELINA CHAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSW,LCSW
Contact information
Practice address
46 ALBION ST, BRIDGEPORT, CT 06605-2602
(203) 330-6000
(203) 330-6008
Mailing address
4 W 125TH ST, FL 2, NEW YORK, NY 10027-4575
(212) 942-5615
(212) 682-2613
Taxonomy
Speciality
Code
Description
License number
State
2084P0804X
Child & Adolescent Psychiatry Physician
Primary
081696-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004236148
—
CT
01
—
008301
LICENSE
CT
Enumeration date
12/19/2012
Last updated
03/15/2018
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