Provider Demographics
NPI:1225335219
Name:WONG, ELLEN (LMSW)
Entity Type:Individual
Prefix:
First Name:ELLEN
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 1:3028 48TH ST
Mailing Address - Street 2:
Mailing Address - City:LONG ISLAND CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11103-1525
Mailing Address - Country:US
Mailing Address - Phone:917-257-5942
Mailing Address - Fax:
Practice Address - Street 1:555 W 57TH ST
Practice Address - Street 2:STE. 1326
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-2925
Practice Address - Country:US
Practice Address - Phone:212-376-1810
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-28
Last Update Date:2013-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY083115-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker