Healthcare Provider Details

I. General information

NPI: 1346336476
Provider Name (Legal Business Name): WAI-POR CHENG L.I.C.S.W.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: RICHARD W.P. CHENG L.I.C.S.W.

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 04/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 E MERRIMACK ST STE 23
LOWELL MA
01852-1900
US

IV. Provider business mailing address

7 WOODBINE ST
READING MA
01867-2346
US

V. Phone/Fax

Practice location:
  • Phone: 978-452-3711
  • Fax: 978-441-9351
Mailing address:
  • Phone: 781-219-7617
  • Fax: 781-942-1607

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1019428
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: