Provider Demographics
NPI:1689929069
Name:TRUONG, MAI BROOKE (MSW)
Entity Type:Individual
Prefix:
First Name:MAI
Middle Name:BROOKE
Last Name:TRUONG
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 E 5TH ST APT 14
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90802-2669
Mailing Address - Country:US
Mailing Address - Phone:562-646-9177
Mailing Address - Fax:
Practice Address - Street 1:700 E 5TH ST APT 14
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90802-2669
Practice Address - Country:US
Practice Address - Phone:562-646-9177
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-20
Last Update Date:2012-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical