=====================================================
General NPI Number Information
=====================================================
NPI Number | 1679530927
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | YUEN LING ELAINE HO LCSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/28/2006
-----------------------------------------------------
Last Update Date | 07/23/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 227 MADISON STREET RM 329 GOUVERNEUR HEALTHCARE SERVICES
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10002
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-238-7369
-----------------------------------------------------
Fax | 218-238-7399
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 105 RAILY COURT
-----------------------------------------------------
City | STATEN ISLAND
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10312
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-605-3701
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 070028
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------