Provider Demographics
NPI:1689121543
Name:WONG, SHU-WEN (PHD)
Entity Type:Individual
Prefix:DR
First Name:SHU-WEN
Middle Name:
Last Name:WONG
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:SHU-WEN
Other - Middle Name:
Other - Last Name:WANG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:14 S BRYN MAWR AVE
Mailing Address - Street 2:
Mailing Address - City:BRYN MAWR
Mailing Address - State:PA
Mailing Address - Zip Code:19010-3216
Mailing Address - Country:US
Mailing Address - Phone:610-525-4828
Mailing Address - Fax:610-525-3216
Practice Address - Street 1:14 S BRYN MAWR AVE
Practice Address - Street 2:
Practice Address - City:BRYN MAWR
Practice Address - State:PA
Practice Address - Zip Code:19010-3216
Practice Address - Country:US
Practice Address - Phone:610-525-4828
Practice Address - Fax:610-525-3216
Is Sole Proprietor?:No
Enumeration Date:2016-09-07
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS017847103TB0200X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral