Provider Demographics
NPI:1932818234
Name:CHUNG, JADE (MS)
Entity Type:Individual
Prefix:
First Name:JADE
Middle Name:
Last Name:CHUNG
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5037 ASHLEY RIVER RD
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33417-8352
Mailing Address - Country:US
Mailing Address - Phone:561-702-3717
Mailing Address - Fax:
Practice Address - Street 1:5037 ASHLEY RIVER RD
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33417-8352
Practice Address - Country:US
Practice Address - Phone:561-702-3717
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-16
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL16995101YM0800X
FLPMH2059101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health