Provider Demographics
NPI:1134197866
Name:WONG, IRVINE V (LCSW)
Entity type:Individual
Prefix:MISS
First Name:IRVINE
Middle Name:V
Last Name:WONG
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16600 WOODRUFF AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:BELLFLOWER
Mailing Address - State:CA
Mailing Address - Zip Code:90706-4916
Mailing Address - Country:US
Mailing Address - Phone:562-920-1600
Mailing Address - Fax:562-920-0895
Practice Address - Street 1:16600 WOODRUFF AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:BELLFLOWER
Practice Address - State:CA
Practice Address - Zip Code:90706-4916
Practice Address - Country:US
Practice Address - Phone:562-920-1600
Practice Address - Fax:562-920-0895
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-09
Last Update Date:2011-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS150361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAS98918Medicare UPIN
CASW15036CMedicare ID - Type Unspecified