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General NPI Number Information
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NPI Number | 1962143966
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Entity Type | Organization
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Legal Business Name | XIAOYAN FAN PHD LLC
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Dates
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Enumeration Date | 04/05/2022
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Last Update Date | 04/05/2022
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Provider Practice Location Address
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Address Line | 186 ALEWIFE BROOK PKWY # 1186
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City | CAMBRIDGE
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State | MA
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Zip | 02138-1121
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Country | US
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Telephone | 781-409-1325
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Fax |
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Provider Business Mailing Address
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Address Line | 41 LAWRENCE LN
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City | BELMONT
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State | MA
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Zip | 02478-3331
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Country | US
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Telephone | 408-834-9758
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Fax |
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Authorized Official
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Title or Position | LICENSED PSYCHOLOGIST
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Name | XIAOYAN FAN
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Credential |
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Telephone | 781-409-1325
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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