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NPI Code Detail

MEDICARE: MR. CARL LEW WONG LCSW

MEDICARE: MR. CARL LEW WONG LCSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social WorkerLJ10624CA

General Provider Information

NPI Number : 1184665754
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. CARL LEW WONG LCSW
Provider Business Mailing Address
First Line : 1501 S 5TH AVE
Second Line :
City : ARCADIA
State : CA
Zip : 91006-4343
Country : US
Telephone Number : 626-574-8695
Fax Number :
Provider Business Practice Location Address
First Line : 351 E TEMPLE ST
Second Line : 11C
City : LOS ANGELES
State : CA
Zip : 90012-3328
Country : US
Telephone Number : 213-253-2677
Fax Number : 213-253-5149
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/08/2006
Last Update Date : 07/08/2007

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