Provider Demographics
NPI:1790512523
Name:JIN LI CHAN, LCSW, LLC
Entity type:Organization
Organization Name:JIN LI CHAN, LCSW, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JIN LI
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSW, PMH-C
Authorized Official - Phone:802-391-4378
Mailing Address - Street 1:PO BOX 33
Mailing Address - Street 2:
Mailing Address - City:LYNDON
Mailing Address - State:VT
Mailing Address - Zip Code:05849-0033
Mailing Address - Country:US
Mailing Address - Phone:802-391-4378
Mailing Address - Fax:
Practice Address - Street 1:37 LEDGE RD
Practice Address - Street 2:
Practice Address - City:LYNDONVILLE
Practice Address - State:VT
Practice Address - Zip Code:05851-4000
Practice Address - Country:US
Practice Address - Phone:802-391-4378
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-16
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty