Provider Demographics
NPI:1275933913
Name:CHUENCHAROENWONG, NEW
Entity Type:Individual
Prefix:
First Name:NEW
Middle Name:
Last Name:CHUENCHAROENWONG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5420 W SAHARA AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89146-0389
Mailing Address - Country:US
Mailing Address - Phone:702-882-7827
Mailing Address - Fax:702-522-9336
Practice Address - Street 1:5420 W SAHARA AVE STE 201
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146
Practice Address - Country:US
Practice Address - Phone:702-882-7827
Practice Address - Fax:702-522-9336
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-29
Last Update Date:2018-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225400000X
NVRBT-16-19980106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner