Basic Information
| Provider Information | |||||||||
| NPI: | 1760882559 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FLUSHING CHINESE COUNSELING LICENSED CLINICAL SOCIAL WORK, P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6130 157TH ST | ||||||||
| Address2: | |||||||||
| City: | FLUSHING | ||||||||
| State: | NY | ||||||||
| PostalCode: | 113671241 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6462676885 | ||||||||
| FaxNumber: | 7188880225 | ||||||||
| Practice Location | |||||||||
| Address1: | 6130 157TH ST | ||||||||
| Address2: | |||||||||
| City: | FLUSHING | ||||||||
| State: | NY | ||||||||
| PostalCode: | 113671241 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6462676885 | ||||||||
| FaxNumber: | 7188880225 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/28/2014 | ||||||||
| LastUpdateDate: | 08/28/2014 | ||||||||
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| AuthorizedOfficialLastName: | CHI | ||||||||
| AuthorizedOfficialFirstName: | XUEJUN | ||||||||
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| AuthorizedOfficialTitleorPosition: | MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 6462676885 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | LCSW | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | 11714 | NY | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 1041C0700X | 079755 | NY | Y | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.