=====================================================
General NPI Number Information
=====================================================
NPI Number | 1679349724
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JULIA E CHA FONG M.A, LAC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/29/2023
-----------------------------------------------------
Last Update Date | 01/02/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 150 MORRISTOWN RD STE 108
-----------------------------------------------------
City | BERNARDSVILLE
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07924-2626
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-982-2888
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12 EASLEY TER
-----------------------------------------------------
City | MORRISTOWN
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07960-6141
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | 37AC00738800
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------