Healthcare Provider Details

I. General information

NPI: 1164782736
Provider Name (Legal Business Name): SEONG CHO-JU LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2012
Last Update Date: 08/02/2024
Certification Date: 07/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BRIAN D. ALLGOOD ARMY COMMUNITY HOSPITAL (BDAACH) UNIT #15245; BLDG 3031
APO AP
96271
US

IV. Provider business mailing address

PSC 307 BOX 4292
APO AP
96224-0043
US

V. Phone/Fax

Practice location:
  • Phone: 315-737-2273
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149.015266
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: