Healthcare Provider Details

I. General information

NPI: 1124880349
Provider Name (Legal Business Name): KAYLA LELANI WONG PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2024
Last Update Date: 01/24/2024
Certification Date: 01/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6576 160TH ST APT 1K
FRESH MEADOWS NY
11365-2503
US

IV. Provider business mailing address

6576 160TH ST APT 1K
FRESH MEADOWS NY
11365-2503
US

V. Phone/Fax

Practice location:
  • Phone: 929-498-1318
  • Fax:
Mailing address:
  • Phone: 929-498-1318
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: