MEDICARE: MRS. JENNY CHUN-YIN CHIM-WONG L.C.S.W.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	069402-1	NY

General Provider Information

NPI Number	:	1679854152
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JENNY CHUN-YIN CHIM-WONG L.C.S.W.

Provider Business Mailing Address
First Line	:	7521 16TH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11214-1005
Country	:	US
Telephone Number	:	917-238-4415
Fax Number	:	718-259-0442

Provider Business Practice Location Address
First Line	:	6501 BAY PKWY
Second Line	:	C LEVEL,
City	:	BROOKLYN
State	:	NY
Zip	:	11204-3948
Country	:	US
Telephone Number	:	917-238-4415
Fax Number	:	718-259-0442

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/29/2011
Last Update Date	:	08/29/2011

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