Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 11106 | MA |
Y | 103TC0700X | Clinical Psychologist | 11106 | MA |
NPI | 1003430125 |
---|---|
Provider Name | Jung-Yang Lin |
First Address | Babson Park, MA 02457 |
Second Address | Wellesley Hills, MA 02481-6834 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/06/2020 |
Last Update Date | 04/06/2020 |