Provider Demographics
NPI:1316378961
Name:KWONG, MICHAEL (LMSW)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:
Last Name:KWONG
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:348 13TH ST.
Mailing Address - Street 2:PARK SLOPE CENTER FOR MENTAL HEALTH
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:11215
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:348 13TH ST
Practice Address - Street 2:503
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-6177
Practice Address - Country:US
Practice Address - Phone:585-507-9279
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-09
Last Update Date:2013-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY251S00000X251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health