Healthcare Provider Details

I. General information

NPI: 1134420375
Provider Name (Legal Business Name): WENJUAN HUANG LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/04/2010
Last Update Date: 02/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

184 ELDRIDGE ST
NEW YORK NY
10002-2924
US

IV. Provider business mailing address

184 ELDRIDGE ST
NEW YORK NY
10002-2924
US

V. Phone/Fax

Practice location:
  • Phone: 212-453-4522
  • Fax:
Mailing address:
  • Phone: 212-453-4500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number084058-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: