Provider Demographics
NPI:1326589276
Name:CHUNG, SUE
Entity Type:Individual
Prefix:
First Name:SUE
Middle Name:
Last Name:CHUNG
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 1:1651 WILLIAMSBRIDGE RD
Mailing Address - Street 2:APT. 3E
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-6249
Mailing Address - Country:US
Mailing Address - Phone:917-797-4716
Mailing Address - Fax:
Practice Address - Street 1:1651 WILLIAMSBRIDGE RD
Practice Address - Street 2:APT. 3E
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-6249
Practice Address - Country:US
Practice Address - Phone:917-797-4716
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-11
Last Update Date:2017-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY740874103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool