Provider Demographics
NPI:1740797091
Name:KONG, KWAN-TING ANDY (LMHC)
Entity Type:Individual
Prefix:
First Name:KWAN-TING
Middle Name:ANDY
Last Name:KONG
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15204 10TH AVE
Mailing Address - Street 2:
Mailing Address - City:WHITESTONE
Mailing Address - State:NY
Mailing Address - Zip Code:11357-1234
Mailing Address - Country:US
Mailing Address - Phone:646-409-0462
Mailing Address - Fax:
Practice Address - Street 1:53 ELIZABETH ST FL 5
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013-4617
Practice Address - Country:US
Practice Address - Phone:212-966-0819
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-09
Last Update Date:2018-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007653-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health