Provider Demographics
NPI:1295883072
Name:WONG, HARVEY (LCSW)
Entity type:Individual
Prefix:MR
First Name:HARVEY
Middle Name:
Last Name:WONG
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:860 W BLACKHAWK ST
Mailing Address - Street 2:#2005
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60642-2510
Mailing Address - Country:US
Mailing Address - Phone:312-654-1586
Mailing Address - Fax:312-983-8288
Practice Address - Street 1:860 W BLACKHAWK ST
Practice Address - Street 2:#2005
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60642-2510
Practice Address - Country:US
Practice Address - Phone:312-654-1586
Practice Address - Fax:312-983-8288
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2010-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490068391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical