Provider Demographics
NPI:1508293796
Name:WONG, KATHERINE (MSW)
Entity Type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:
Last Name:WONG
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:
Other - Last Name:LIN-WONG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:54 DELANO CT
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11040-3157
Mailing Address - Country:US
Mailing Address - Phone:516-354-6846
Mailing Address - Fax:
Practice Address - Street 1:54 DELANO CT
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11040-3157
Practice Address - Country:US
Practice Address - Phone:516-354-6846
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-02
Last Update Date:2013-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY052784104100000X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No104100000XBehavioral Health & Social Service ProvidersSocial Worker