1386182400 NPI number — DR. CHANDRA MERRY PSYD, MA

Table of content: DR. CHANDRA MERRY PSYD, MA (NPI 1386182400)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386182400 NPI number — DR. CHANDRA MERRY PSYD, MA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MERRY
Provider First Name:
CHANDRA
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PSYD, MA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1386182400
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/16/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 UNIVERSITY NEW MEXICO MSC09-5030 UNIVERSITY OF NEW
Provider Second Line Business Mailing Address:
MEXICO HEALTH SCIENCES CENTER DEPARTMENT OF PSYCHIATRY
Provider Business Mailing Address City Name:
ALBUQUERQUE
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
87131-0001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
510-548-9716
Provider Business Mailing Address Fax Number:
510-841-1284

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1000 W CARSON ST # 488
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TORRANCE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90502-2004
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
424-306-5737
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/09/2017

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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