Provider Demographics
NPI:1114812526
Name:CHAN, MICHAEL K (MA)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:K
Last Name:CHAN
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:373 HIGHLAND AVE APT 323
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02144-2555
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:352 MIDDLESEX RD
Practice Address - Street 2:
Practice Address - City:TYNGSBORO
Practice Address - State:MA
Practice Address - Zip Code:01879-1076
Practice Address - Country:US
Practice Address - Phone:781-328-1904
Practice Address - Fax:781-328-4733
Is Sole Proprietor?:No
Enumeration Date:2025-06-09
Last Update Date:2025-06-09
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health