Healthcare Provider Details

I. General information

NPI: 1699548909
Provider Name (Legal Business Name): DEJIA YANG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/30/2023
Last Update Date: 03/30/2026
Certification Date: 03/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1968 CENTRAL AVE
NEEDHAM MA
02492-1410
US

IV. Provider business mailing address

55 STATION LNDG
MEDFORD MA
02155-5007
US

V. Phone/Fax

Practice location:
  • Phone: 781-292-2196
  • Fax: 781-292-2196
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLMHC10005631
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: