Healthcare Provider Details

I. General information

NPI: 1144655622
Provider Name (Legal Business Name): YOO-YUN CHO-CHANG PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2013
Last Update Date: 04/04/2022
Certification Date: 04/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

76 BEDFORD ST STE 25
LEXINGTON MA
02420-4641
US

IV. Provider business mailing address

71 FREEMONT ST
LEXINGTON MA
02421-6528
US

V. Phone/Fax

Practice location:
  • Phone: 603-491-9403
  • Fax:
Mailing address:
  • Phone: 603-491-9403
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number10837
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: