Provider Demographics
NPI:1346312923
Name:NICOLA CHUNG, PH.D., LLC
Entity Type:Organization
Organization Name:NICOLA CHUNG, PH.D., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MGRM
Authorized Official - Prefix:DR
Authorized Official - First Name:NICOLA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHUNG
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:305-490-8590
Mailing Address - Street 1:1021 IVES DAIRY RD
Mailing Address - Street 2:SUITE 119
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33179-2537
Mailing Address - Country:US
Mailing Address - Phone:305-490-8590
Mailing Address - Fax:
Practice Address - Street 1:1021 IVES DAIRY RD
Practice Address - Street 2:SUITE 119
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33179-2537
Practice Address - Country:US
Practice Address - Phone:305-490-8590
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2013-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY 7307103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty