Basic Information
| Provider Information | |||||||||
| NPI: | 1043598915 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JONG | ||||||||
| FirstName: | CINDY | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PSY.D. | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 919 1ST ST | ||||||||
| Address2: | |||||||||
| City: | SAN FERNANDO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913402957 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8182561124 | ||||||||
| FaxNumber: | 8183613217 | ||||||||
| Practice Location | |||||||||
| Address1: | 919 1ST ST | ||||||||
| Address2: | |||||||||
| City: | SAN FERNANDO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913402957 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8182561124 | ||||||||
| FaxNumber: | 8183613217 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/26/2011 | ||||||||
| LastUpdateDate: | 01/21/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 01/21/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | PSY 22406 | CA | Y | Behavioral Health & Social Service Providers | Psychologist |
No ID Information.