Provider Demographics
NPI:1811313729
Name:KONG, KWAI FONG (LMHC)
Entity type:Individual
Prefix:
First Name:KWAI
Middle Name:FONG
Last Name:KONG
Suffix:
Gender:F
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:PO BOX 664
Mailing Address - Street 2:
Mailing Address - City:PRINCETON JUNCTION
Mailing Address - State:NJ
Mailing Address - Zip Code:08550-0664
Mailing Address - Country:US
Mailing Address - Phone:609-647-5664
Mailing Address - Fax:
Practice Address - Street 1:55 CHRYSTIE ST
Practice Address - Street 2:SUITE 407
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10002-5042
Practice Address - Country:US
Practice Address - Phone:212-966-0899
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-16
Last Update Date:2014-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005978-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health