Healthcare Provider Details

I. General information

NPI: 1164349007
Provider Name (Legal Business Name): CHING YAN PHYLLIS LAM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: PHYLLIS LAM

II. Dates (important events)

Enumeration Date: 07/01/2026
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 WINDING BROOK DR APT 1H
GUILDERLAND NY
12084-9746
US

IV. Provider business mailing address

10 WINDING BROOK DR APT 1H
GUILDERLAND NY
12084-9746
US

V. Phone/Fax

Practice location:
  • Phone: 212-518-3863
  • Fax:
Mailing address:
  • Phone: 212-518-3863
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: