Provider Demographics
NPI:1407925878
Name:WONG, MARICRES LEW (MSW)
Entity Type:Individual
Prefix:MRS
First Name:MARICRES
Middle Name:LEW
Last Name:WONG
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:MISS
Other - First Name:MARICRES
Other - Middle Name:A
Other - Last Name:LEW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:201 CENTRE PLAZA DRIVE
Mailing Address - Street 2:DEPARTMENT 425
Mailing Address - City:MONTEREY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91754
Mailing Address - Country:US
Mailing Address - Phone:323-526-6383
Mailing Address - Fax:323-260-5251
Practice Address - Street 1:201 CENTRE PLAZA DRIVE
Practice Address - Street 2:DEPARTMENT 425
Practice Address - City:MONTEREY PARK
Practice Address - State:CA
Practice Address - Zip Code:91754
Practice Address - Country:US
Practice Address - Phone:323-526-6383
Practice Address - Fax:323-260-5251
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 207371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical