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General NPI Number Information
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NPI Number | 1871946673
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Entity Type | Organization
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Legal Business Name | JEANNE E. PHUNG, LCSW, LLC
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Dates
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Enumeration Date | 07/16/2016
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Last Update Date | 07/16/2016
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Provider Practice Location Address
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Address Line | 30 CONTROLS DR SUITE 10
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City | SHELTON
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State | CT
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Zip | 06484-6157
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Country | US
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Telephone | 203-525-8280
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Fax |
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Provider Business Mailing Address
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Address Line | 30 CONTROLS DR SUITE 10
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City | SHELTON
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State | CT
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Zip | 06484-6157
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Country | US
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Telephone | 203-525-8280
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Fax |
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Authorized Official
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Title or Position | LCSW/PRIVATE PRACTICE OWNER
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Name | JEANNE E. PHUNG
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Credential | LCSW
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Telephone | 203-525-8280
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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 | 009069
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License Number State | CT
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