Provider Demographics
NPI:1609613470
Name:CHEN, SIJIA
Entity type:Individual
Prefix:
First Name:SIJIA
Middle Name:
Last Name:CHEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:337 MANSFIELD RD
Mailing Address - Street 2:
Mailing Address - City:STORRS
Mailing Address - State:CT
Mailing Address - Zip Code:06269-9015
Mailing Address - Country:US
Mailing Address - Phone:860-486-4705
Mailing Address - Fax:860-485-9159
Practice Address - Street 1:337 MANSFIELD RD
Practice Address - Street 2:
Practice Address - City:STORRS
Practice Address - State:CT
Practice Address - Zip Code:06269-9015
Practice Address - Country:US
Practice Address - Phone:860-486-4705
Practice Address - Fax:860-485-9159
Is Sole Proprietor?:No
Enumeration Date:2024-07-10
Last Update Date:2024-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT7506101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional