Provider Demographics
NPI:1114591997
Name:NGUYEN, DUNG THUY (ASW)
Entity Type:Individual
Prefix:
First Name:DUNG
Middle Name:THUY
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:ASW
Other - Prefix:
Other - First Name:LORIE
Other - Middle Name:
Other - Last Name:NGUYEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ASW
Mailing Address - Street 1:521 AVENUE G APT B
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90277-6036
Mailing Address - Country:US
Mailing Address - Phone:909-235-4868
Mailing Address - Fax:
Practice Address - Street 1:521 AVENUE G APT B
Practice Address - Street 2:
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90277-6036
Practice Address - Country:US
Practice Address - Phone:909-235-4868
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-17
Last Update Date:2021-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW823321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical