Healthcare Provider Details

I. General information

NPI: 1790935989
Provider Name (Legal Business Name): LILLIAN CHIANG PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/24/2008
Last Update Date: 09/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2222 BANCROFT WAY SPC 4300 UNIVERSITY OF CALIFORNIA BERKELEY
BERKELEY CA
94720-4300
US

IV. Provider business mailing address

2222 BANCROFT WAY, MAIL CODE 4300 UNIVERSITY OF CALIFORNIA BERKELEY
BERKELEY CA
94720-4304
US

V. Phone/Fax

Practice location:
  • Phone: 510-642-2709
  • Fax: 510-642-2368
Mailing address:
  • Phone: 510-642-2709
  • Fax: 510-642-2368

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: