Provider Demographics
NPI:1366227308
Name:SUN, QUAN (LMHC-LP)
Entity type:Individual
Prefix:
First Name:QUAN
Middle Name:
Last Name:SUN
Suffix:
Gender:F
Credentials:LMHC-LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 E STATE ST APT 524
Mailing Address - Street 2:
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-4089
Mailing Address - Country:US
Mailing Address - Phone:347-459-0554
Mailing Address - Fax:
Practice Address - Street 1:8825 153RD ST APT 2P
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-3752
Practice Address - Country:US
Practice Address - Phone:347-459-0554
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-29
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health