MEDICARE: MEESHA CHAN LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	44SC06326100	NJ
2	1041C0700X	Clinical Social Worker	089181-01	NY

General Provider Information

NPI Number	:	1447611025
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MEESHA CHAN LCSW

Provider Business Mailing Address
First Line	:	8 DEFEO CT
Second Line	:
City	:	DEER PARK
State	:	NY
Zip	:	11729-1834
Country	:	US
Telephone Number	:	631-942-5429
Fax Number	:

Provider Business Practice Location Address
First Line	:	2 BUCKINGHAM RD
Second Line	:
City	:	LINCOLN PARK
State	:	NJ
Zip	:	07035-1444
Country	:	US
Telephone Number	:	631-942-5429
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/10/2016
Last Update Date	:	09/01/2024

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Directions to “ MEESHA CHAN LCSW” Practice Location

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