Provider Demographics
NPI:1114283603
Name:FONG, MILKA D (MED)
Entity Type:Individual
Prefix:MRS
First Name:MILKA
Middle Name:D
Last Name:FONG
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 415
Mailing Address - Street 2:
Mailing Address - City:WEYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02190-0007
Mailing Address - Country:US
Mailing Address - Phone:781-733-5694
Mailing Address - Fax:339-645-4090
Practice Address - Street 1:46 GREENTREE LN
Practice Address - Street 2:
Practice Address - City:WEYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02190-2055
Practice Address - Country:US
Practice Address - Phone:781-733-5694
Practice Address - Fax:617-516-0281
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-09
Last Update Date:2014-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist