MEDICARE: ALICE WONG

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1902283500
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALICE WONG

Provider Business Mailing Address
First Line	:	6618 20TH AVE UNIT 40158
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11204-3986
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6618 20TH AVE UNIT 40158
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11204-3986
Country	:	US
Telephone Number	:	646-580-8896
Fax Number	:

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

Provider Enumeration Date	:	05/04/2015
Last Update Date	:	11/15/2025

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