Provider Demographics
NPI:1609071703
Name:CHUNG, MINA (PHD)
Entity Type:Individual
Prefix:DR
First Name:MINA
Middle Name:
Last Name:CHUNG
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 COUNTY RD
Mailing Address - Street 2:
Mailing Address - City:BARRINGTON
Mailing Address - State:RI
Mailing Address - Zip Code:02806-4502
Mailing Address - Country:US
Mailing Address - Phone:401-340-7141
Mailing Address - Fax:
Practice Address - Street 1:205 WATERMAN ST STE 203
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02906-4313
Practice Address - Country:US
Practice Address - Phone:401-326-2845
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-19
Last Update Date:2019-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPS01018103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical