Basic Information
| Provider Information | |||||||||
| NPI: | 1528105210 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WONG | ||||||||
| FirstName: | KWAN | ||||||||
| MiddleName: | K | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | L.C.S.W.R | ||||||||
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| Mailing Information | |||||||||
| Address1: | 34 ARBOR RD | ||||||||
| Address2: | |||||||||
| City: | SYOSSET | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117914901 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5165846285 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 14015B SANFORD AVE FL 2 | ||||||||
| Address2: | |||||||||
| City: | FLUSHING | ||||||||
| State: | NY | ||||||||
| PostalCode: | 113552557 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7183588288 | ||||||||
| FaxNumber: | 7183585265 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/31/2007 | ||||||||
| LastUpdateDate: | 04/03/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | R049693-1 | NY | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.