Basic Information
| Provider Information | |||||||||
| NPI: | 1386182400 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MERRY | ||||||||
| FirstName: | CHANDRA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | PSYD, MA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 UNIVERSITY NEW MEXICO MSC09-5030 UNIVERSITY OF NEW | ||||||||
| Address2: | MEXICO HEALTH SCIENCES CENTER DEPARTMENT OF PSYCHIATRY | ||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871310001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5105489716 | ||||||||
| FaxNumber: | 5108411284 | ||||||||
| Practice Location | |||||||||
| Address1: | 1000 W CARSON ST # 488 | ||||||||
| Address2: | |||||||||
| City: | TORRANCE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 905022004 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4243065737 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/09/2017 | ||||||||
| LastUpdateDate: | 09/16/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/07/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.