Basic Information
| Provider Information | |||||||||
| NPI: | 1235225384 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WONG | ||||||||
| FirstName: | NELSON | ||||||||
| MiddleName: | K | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | LICSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 800 WASHINGTON STREET | ||||||||
| Address2: | SOCIAL WORK SERVICES, TUFTS MEDICAL CENTER, #790 | ||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021111526 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6176365716 | ||||||||
| FaxNumber: | 6176365138 | ||||||||
| Practice Location | |||||||||
| Address1: | 800 WASHINGTON ST | ||||||||
| Address2: | SOCIAL WORK SERVICES, TUFTS MEDICAL CENTER, #790 | ||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021111552 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6176365716 | ||||||||
| FaxNumber: | 6176365138 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/05/2006 | ||||||||
| LastUpdateDate: | 11/20/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 1022451 | MA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.