Healthcare Provider Details

I. General information

NPI: 1922872498
Provider Name (Legal Business Name): JOHNNY FANG MSW, LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2023
Last Update Date: 10/03/2025
Certification Date: 10/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

257 MAIN ST
BINGHAMTON NY
13905-2596
US

IV. Provider business mailing address

257 MAIN ST
BINGHAMTON NY
13905-2596
US

V. Phone/Fax

Practice location:
  • Phone: 607-729-6206
  • Fax:
Mailing address:
  • Phone: 607-729-6206
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number121286
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: