Provider Demographics
NPI:1538822267
Name:YAN, CHRISTINA W (LMSW)
Entity type:Individual
Prefix:MS
First Name:CHRISTINA
Middle Name:W
Last Name:YAN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:414 HICKS ST APT 102
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-6680
Mailing Address - Country:US
Mailing Address - Phone:646-734-5929
Mailing Address - Fax:
Practice Address - Street 1:44 E 12TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-4632
Practice Address - Country:US
Practice Address - Phone:646-734-5929
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-19
Last Update Date:2021-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1137351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY113735OtherNEW YORK STATE OFFICE OF THE PROFESSIONS, LMSW LICENSE