Healthcare Provider Details

I. General information

NPI: 1407051808
Provider Name (Legal Business Name): DEBORAH K FUNG LCAT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2007
Last Update Date: 07/15/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2925A KINGS HWY
BROOKLYN NY
11229-1805
US

IV. Provider business mailing address

80 ELIZABETH ST APT 5Q
NEW YORK NY
10013
US

V. Phone/Fax

Practice location:
  • Phone: 917-565-8294
  • Fax:
Mailing address:
  • Phone: 917-426-1332
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number002115
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: