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General NPI Number Information
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NPI Number | 1225335219
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Entity Type | Individual
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Provider Name | ELLEN WONG LMSW
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Gender | Female
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Dates
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Enumeration Date | 02/28/2011
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Last Update Date | 08/14/2013
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Provider Practice Location Address
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Address Line | 555 W 57TH ST STE. 1326
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City | NEW YORK
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State | NY
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Zip | 10019-2925
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Country | US
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Telephone | 212-376-1810
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Fax |
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Provider Business Mailing Address
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Address Line | 3028 48TH ST
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City | LONG ISLAND CITY
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State | NY
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Zip | 11103-1525
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Country | US
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Telephone | 917-257-5942
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 083115-1
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License Number State | NY
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