Provider Demographics
NPI:1679540629
Name:CHUNG, MARGARET M (LICSW)
Entity type:Individual
Prefix:
First Name:MARGARET
Middle Name:M
Last Name:CHUNG
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:585-597 MERRIMACK STREET
Mailing Address - Street 2:LOWELL COMMUNITY HEALTH CENTER
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01854
Mailing Address - Country:US
Mailing Address - Phone:978-446-0788
Mailing Address - Fax:978-453-1777
Practice Address - Street 1:15-17 WARREN STREET
Practice Address - Street 2:LOWELL COMMUNITY HEALTH CENTER
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01852
Practice Address - Country:US
Practice Address - Phone:978-446-0788
Practice Address - Fax:978-453-1777
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1114251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q08603Medicare UPIN
MAP23273Medicare ID - Type Unspecified