Provider Demographics
NPI:1083365035
Name:WONG, JODY NIKIA (LMSW)
Entity Type:Individual
Prefix:MISS
First Name:JODY
Middle Name:NIKIA
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 1:8 MILLDOWN RD
Mailing Address - Street 2:
Mailing Address - City:YAPHANK
Mailing Address - State:NY
Mailing Address - Zip Code:11980-9770
Mailing Address - Country:US
Mailing Address - Phone:347-622-3922
Mailing Address - Fax:
Practice Address - Street 1:8 MILLDOWN RD
Practice Address - Street 2:
Practice Address - City:YAPHANK
Practice Address - State:NY
Practice Address - Zip Code:11980-9770
Practice Address - Country:US
Practice Address - Phone:347-622-3922
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-11
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY113158104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker