Healthcare Provider Details

I. General information

NPI: 1801343488
Provider Name (Legal Business Name): LINA LEUNG PSY.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2016
Last Update Date: 09/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3512 QUENTIN ROAD SUITE 110
BROOKLYN NY
11234-4245
US

IV. Provider business mailing address

3512 QUENTIN ROAD SUITE 110
BROOKLYN NY
11234-4245
US

V. Phone/Fax

Practice location:
  • Phone: 800-275-3243
  • Fax: 855-688-6746
Mailing address:
  • Phone: 800-275-3243
  • Fax: 855-688-6746

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number021645-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: