Provider Demographics
NPI:1003286766
Name:WONG, DEBI (LMSW)
Entity Type:Individual
Prefix:MS
First Name:DEBI
Middle Name:
Last Name:WONG
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1983 MARCUS AVE STE C102
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11042-2006
Mailing Address - Country:US
Mailing Address - Phone:516-876-4100
Mailing Address - Fax:516-876-4101
Practice Address - Street 1:1983 MARCUS AVE STE C102
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11042-2006
Practice Address - Country:US
Practice Address - Phone:516-876-4100
Practice Address - Fax:516-876-4101
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-06
Last Update Date:2015-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY074493104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY074493OtherTHE UNIVERSITY OF THE STATE OF NEW YORK
NYYK306649DSOtherDEPARTMENT OF HEALTH