MEDICARE: MS. ERIN CHUNG LCSW

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
2	1041C0700X	Clinical Social Worker	0869031	NY
3	1041C0700X	Clinical Social Worker	085110	NY

General Provider Information

NPI Number	:	1952637233
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ERIN CHUNG LCSW

Provider Business Mailing Address
First Line	:	11835 QUEENS BLVD
Second Line	:	SIXTH FLOOR
City	:	FOREST HILLS
State	:	NY
Zip	:	11375-7200
Country	:	US
Telephone Number	:	718-651-7770
Fax Number	:

Provider Business Practice Location Address
First Line	:	11835 QUEENS BLVD
Second Line	:	SIXTH FLOOR
City	:	FOREST HILLS
State	:	NY
Zip	:	11375-7200
Country	:	US
Telephone Number	:	718-651-7770
Fax Number	:

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

Provider Enumeration Date	:	10/21/2009
Last Update Date	:	01/11/2017

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