Provider Demographics
NPI:1043452006
Name:CHANDA, KAREN ANN (EARLY INTERVENTION)
Entity type:Individual
Prefix:MISS
First Name:KAREN
Middle Name:ANN
Last Name:CHANDA
Suffix:
Gender:F
Credentials:EARLY INTERVENTION
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 WALNUT RD
Mailing Address - Street 2:
Mailing Address - City:KINGS PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11754-2427
Mailing Address - Country:US
Mailing Address - Phone:631-979-3861
Mailing Address - Fax:
Practice Address - Street 1:23 S BEECH ST # B102
Practice Address - Street 2:
Practice Address - City:CORTEZ
Practice Address - State:CO
Practice Address - Zip Code:81321-3751
Practice Address - Country:US
Practice Address - Phone:970-946-1539
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-06
Last Update Date:2021-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No174400000XOther Service ProvidersSpecialist