MEDICARE: DR. CONSTANCE SING WAI CHAN PHD

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	3135	MA

General Provider Information

NPI Number	:	1801388913
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CONSTANCE SING WAI CHAN PHD

Provider Business Mailing Address
First Line	:	211 ROCK HARBOR RD
Second Line	:
City	:	ORLEANS
State	:	MA
Zip	:	02653-2308
Country	:	US
Telephone Number	:	617-438-3480
Fax Number	:

Provider Business Practice Location Address
First Line	:	211 ROCK HARBOR RD
Second Line	:
City	:	ORLEANS
State	:	MA
Zip	:	02653-2308
Country	:	US
Telephone Number	:	617-438-3480
Fax Number	:

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

Provider Enumeration Date	:	06/04/2018
Last Update Date	:	06/04/2018

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