Healthcare Provider Details

I. General information

NPI: 1679187017
Provider Name (Legal Business Name): THEODORE NG
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2020
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 THOMPSON RD
WEBSTER MA
01570-1509
US

IV. Provider business mailing address

77 WORCESTER RD
WEBSTER MA
01570-2101
US

V. Phone/Fax

Practice location:
  • Phone: 508-949-8693
  • Fax:
Mailing address:
  • Phone: 508-640-5797
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: