Provider Demographics
NPI:1346336476
Name:CHENG, WAI-POR (LICSW)
Entity Type:Individual
Prefix:MR
First Name:WAI-POR
Middle Name:
Last Name:CHENG
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:MR
Other - First Name:RICHARD
Other - Middle Name:WP
Other - Last Name:CHENG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LICSW
Mailing Address - Street 1:7 WOODBINE ST
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:MA
Mailing Address - Zip Code:01867-2346
Mailing Address - Country:US
Mailing Address - Phone:781-219-7617
Mailing Address - Fax:781-942-1607
Practice Address - Street 1:77 E MERRIMACK ST STE 23
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01852-1900
Practice Address - Country:US
Practice Address - Phone:978-452-3711
Practice Address - Fax:978-441-9351
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2018-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10194281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110032066AMedicaid