Provider Demographics
NPI:1003856121
Name:CHUNG, NICOLA MARIE (PHD)
Entity Type:Individual
Prefix:DR
First Name:NICOLA
Middle Name:MARIE
Last Name:CHUNG
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1021 IVES DAIRY RD
Mailing Address - Street 2:SUITE 119
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33179-2537
Mailing Address - Country:US
Mailing Address - Phone:305-490-8590
Mailing Address - Fax:
Practice Address - Street 1:1021 IVES DAIRY RD
Practice Address - Street 2:SUITE 119
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33179-2537
Practice Address - Country:US
Practice Address - Phone:305-490-8590
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-07
Last Update Date:2013-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY 7307103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical