Provider Demographics
NPI:1871249656
Name:CHUNG PSYCHOTHERAPY LCSW LLC
Entity Type:Organization
Organization Name:CHUNG PSYCHOTHERAPY LCSW LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL LICENSED SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:S
Authorized Official - Last Name:CHUNG
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:551-697-3845
Mailing Address - Street 1:296 CROCKER PL
Mailing Address - Street 2:
Mailing Address - City:HAWORTH
Mailing Address - State:NJ
Mailing Address - Zip Code:07641-1206
Mailing Address - Country:US
Mailing Address - Phone:551-697-3845
Mailing Address - Fax:
Practice Address - Street 1:140 COUNTY RD STE 106
Practice Address - Street 2:
Practice Address - City:TENAFLY
Practice Address - State:NJ
Practice Address - Zip Code:07670-1842
Practice Address - Country:US
Practice Address - Phone:551-697-3845
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHUNG PSYCHOTHERAPY LCSW LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-03-01
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty