Healthcare Provider Details

I. General information

NPI: 1710939632
Provider Name (Legal Business Name): TAMMY THAO NGUYEN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 CHRYSTIE ST SUITE 407
NEW YORK NY
10002-5042
US

IV. Provider business mailing address

81 FORT GREENE PL
BROOKLYN NY
11217-1218
US

V. Phone/Fax

Practice location:
  • Phone: 917-664-7082
  • Fax:
Mailing address:
  • Phone: 917-664-7082
  • Fax: 718-613-4381

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number072395
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: