Healthcare Provider Details

I. General information

NPI: 1346443108
Provider Name (Legal Business Name): HEATHER JEAN HUANG LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4119 WHITE PLAINS RD
BRONX NY
10466-3007
US

IV. Provider business mailing address

15517 SANFORD AVE APT 3F
FLUSHING NY
11355-1157
US

V. Phone/Fax

Practice location:
  • Phone: 718-652-0227
  • Fax:
Mailing address:
  • Phone: 718-353-7633
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number73-074176
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: