Provider Demographics
NPI:1861825028
Name:CHONG, AMY JOHNSON (LMT, LICSW)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:JOHNSON
Last Name:CHONG
Suffix:
Gender:F
Credentials:LMT, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 SHELL PT E
Mailing Address - Street 2:
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-5843
Mailing Address - Country:US
Mailing Address - Phone:407-443-5005
Mailing Address - Fax:
Practice Address - Street 1:201 SHELL PT E
Practice Address - Street 2:
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751-5843
Practice Address - Country:US
Practice Address - Phone:407-443-5005
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-12
Last Update Date:2013-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical