Provider Demographics
NPI:1679091938
Name:CHRISTINE WONG, PSYD, A PROFESSIONAL CORP
Entity Type:Organization
Organization Name:CHRISTINE WONG, PSYD, A PROFESSIONAL CORP
Other - Org Name:CHRISTINE WONG, PSYD, A PROFESSIONAL CORP
Other - Org Type:Other Name
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:WONG
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:909-833-1596
Mailing Address - Street 1:427 YALE AVE # 200
Mailing Address - Street 2:
Mailing Address - City:CLAREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:91711-4340
Mailing Address - Country:US
Mailing Address - Phone:909-833-1596
Mailing Address - Fax:626-338-9022
Practice Address - Street 1:427 YALE AVE # 200
Practice Address - Street 2:
Practice Address - City:CLAREMONT
Practice Address - State:CA
Practice Address - Zip Code:91711-4340
Practice Address - Country:US
Practice Address - Phone:909-833-1596
Practice Address - Fax:626-338-9022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-06
Last Update Date:2017-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY21007103T00000X, 103TC0700X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty