Healthcare Provider Details

I. General information

NPI: 1902147200
Provider Name (Legal Business Name): ALICIA WU MHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/12/2013
Last Update Date: 03/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8020 45TH AVE
ELMHURST NY
11373-3545
US

IV. Provider business mailing address

36 MULBERRY ST # 38 APT. 4
NEW YORK NY
10013-4347
US

V. Phone/Fax

Practice location:
  • Phone: 718-478-2900
  • Fax: 718-478-3456
Mailing address:
  • Phone: 732-995-1640
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: