Healthcare Provider Details

I. General information

NPI: 1407300650
Provider Name (Legal Business Name): FENGTAO HUANG LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2016
Last Update Date: 01/27/2025
Certification Date: 01/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6431 108TH ST STE 1284
FOREST HILLS NY
11375-1612
US

IV. Provider business mailing address

6431 108TH ST STE 1284
FOREST HILLS NY
11375-1612
US

V. Phone/Fax

Practice location:
  • Phone: 646-572-6908
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number089925
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number35660
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number101232
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: