Healthcare Provider Details

I. General information

NPI: 1750929808
Provider Name (Legal Business Name): CATHERINE YANG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2019
Last Update Date: 09/22/2022
Certification Date: 09/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 TUFTS ST
CHARLESTOWN MA
02129-2711
US

IV. Provider business mailing address

10 PARSONAGE RD STE 318
EDISON NJ
08837-2429
US

V. Phone/Fax

Practice location:
  • Phone: 857-238-1195
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number228207
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: