Healthcare Provider Details

I. General information

NPI: 1831708791
Provider Name (Legal Business Name): JACQUELINE H WONG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2020
Last Update Date: 09/10/2020
Certification Date: 09/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 SCHALKS CROSSING RD STE 501A-105
PLAINSBORO NJ
08536-1612
US

IV. Provider business mailing address

12 GRACE CT
PLAINSBORO NJ
08536-1625
US

V. Phone/Fax

Practice location:
  • Phone: 609-336-3317
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number37PC00724000
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number37PC00724000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: