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General NPI Number Information
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NPI Number | 1396281424
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Entity Type | Individual
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Provider Name | JENNIE CHUNG LCSW-R
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Gender | Female
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Dates
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Enumeration Date | 01/12/2017
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Last Update Date | 04/29/2022
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Provider Practice Location Address
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Address Line | 114 5TH AVE FL 2
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City | NEW YORK
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State | NY
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Zip | 10011-5611
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Country | US
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Telephone | 718-415-5193
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Fax |
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Provider Business Mailing Address
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Address Line | 800 THIRD AVENUE SUITE A #1050
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City | NEW YORK
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State | NY
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Zip | 10022
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Country | US
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Telephone | 718-415-5193
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 73 084268
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License Number State | NY
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