Healthcare Provider Details

I. General information

NPI: 1134743651
Provider Name (Legal Business Name): LIN TANG PH.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2020
Last Update Date: 06/01/2020
Certification Date: 06/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 ROLLING RIDGE RD
AMHERST MA
01002-1419
US

IV. Provider business mailing address

60 ROLLING RIDGE RD
AMHERST MA
01002-1419
US

V. Phone/Fax

Practice location:
  • Phone: 914-522-2659
  • Fax:
Mailing address:
  • Phone: 914-522-2659
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number11082-PY-PR
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: