Basic Information
| Provider Information | |||||||||
| NPI: | 1568750115 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FU | ||||||||
| FirstName: | TAO-WEN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2259 27TH ST | ||||||||
| Address2: | #3A | ||||||||
| City: | ASTORIA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 111053138 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9178565249 | ||||||||
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| Practice Location | |||||||||
| Address1: | 14015B SANFORD AVE | ||||||||
| Address2: | 2FL | ||||||||
| City: | FLUSHING | ||||||||
| State: | NY | ||||||||
| PostalCode: | 113552557 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7183588288 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/18/2011 | ||||||||
| LastUpdateDate: | 07/18/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.