Basic Information
| Provider Information | |||||||||
| NPI: | 1861964405 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LI | ||||||||
| FirstName: | ZHEN | ||||||||
| MiddleName: | |||||||||
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| OtherLastName: | HAN | ||||||||
| OtherFirstName: | ZHEN | ||||||||
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| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 11835 QUEENS BLVD FL 6 | ||||||||
| Address2: | |||||||||
| City: | FOREST HILLS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 113757211 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7186517770 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 11835 QUEENS BLVD FL 6 | ||||||||
| Address2: | |||||||||
| City: | FOREST HILLS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 113757211 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7186517770 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/20/2018 | ||||||||
| LastUpdateDate: | 12/06/2019 | ||||||||
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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 | N | Behavioral Health & Social Service Providers | Social Worker | 104100000X | 107963 | NY | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.