Provider Demographics
NPI:1376631135
Name:GONG, KATHERINE S (LCSW, DCSW)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:S
Last Name:GONG
Suffix:
Gender:F
Credentials:LCSW, DCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 371836
Mailing Address - Street 2:
Mailing Address - City:KEY LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33037-1836
Mailing Address - Country:US
Mailing Address - Phone:305-394-4006
Mailing Address - Fax:305-451-2816
Practice Address - Street 1:103400 OVERSEAS HWY
Practice Address - Street 2:SUITE 201/202
Practice Address - City:KEY LARGO
Practice Address - State:FL
Practice Address - Zip Code:33037-2834
Practice Address - Country:US
Practice Address - Phone:305-394-4006
Practice Address - Fax:305-451-2816
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2009-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW 54501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ062EOtherBLUE CROSS BLUE SHIELD