Provider Demographics
NPI:1235225384
Name:WONG, NELSON K (LICSW)
Entity Type:Individual
Prefix:MR
First Name:NELSON
Middle Name:K
Last Name:WONG
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 WASHINGTON STREET
Mailing Address - Street 2:SOCIAL WORK SERVICES, TUFTS MEDICAL CENTER, #790
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02111-1526
Mailing Address - Country:US
Mailing Address - Phone:617-636-5716
Mailing Address - Fax:617-636-5138
Practice Address - Street 1:800 WASHINGTON ST
Practice Address - Street 2:SOCIAL WORK SERVICES, TUFTS MEDICAL CENTER, #790
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02111-1552
Practice Address - Country:US
Practice Address - Phone:617-636-5716
Practice Address - Fax:617-636-5138
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2008-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10224511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical