Healthcare Provider Details

I. General information

NPI: 1508431511
Provider Name (Legal Business Name): ELITA WONG, PSYCHIATRIC NURSE PRACTITIONER PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2021
Last Update Date: 05/21/2021
Certification Date: 05/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

223 BEDFORD AVE NO. 888
BROOKLYN NY
11211
US

IV. Provider business mailing address

223 BEDFORD AVE NO. 888
BROOKLYN NY
11211
US

V. Phone/Fax

Practice location:
  • Phone: 206-531-7844
  • Fax: 503-386-3252
Mailing address:
  • Phone: 206-531-7844
  • Fax: 503-386-3252

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number
License Number State

VIII. Authorized Official

Name: ELITA WONG
Title or Position: OWNER, PSYCHIATRIC NP
Credential: PMHNP-BC
Phone: 206-531-7844