MEDICARE: MARILYN MONICA CHEN PH.D.

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	103TC0700X	Clinical Psychologist	PSY24581	CA
2	103TC0700X	Clinical Psychologist	019935-1	NY

General Provider Information

NPI Number	:	1740566520
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARILYN MONICA CHEN PH.D.

Provider Business Mailing Address
First Line	:	134 BROADWAY FL 4
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11249-6233
Country	:	US
Telephone Number	:	805-403-6010
Fax Number	:

Provider Business Practice Location Address
First Line	:	134 BROADWAY FL 4
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11249-6233
Country	:	US
Telephone Number	:	805-403-6010
Fax Number	:

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

Provider Enumeration Date	:	10/25/2011
Last Update Date	:	04/16/2026

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