Provider Demographics
NPI:1679854152
Name:CHIM-WONG, JENNY CHUN-YIN (LCSW)
Entity type:Individual
Prefix:MRS
First Name:JENNY
Middle Name:CHUN-YIN
Last Name:CHIM-WONG
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:JENNY
Other - Middle Name:CHUN-YIN
Other - Last Name:CHIM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:7521 16TH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11214-1005
Mailing Address - Country:US
Mailing Address - Phone:917-238-4415
Mailing Address - Fax:718-259-0442
Practice Address - Street 1:6501 BAY PKWY
Practice Address - Street 2:C LEVEL,
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11204-3948
Practice Address - Country:US
Practice Address - Phone:917-238-4415
Practice Address - Fax:718-259-0442
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-29
Last Update Date:2011-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY069402-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical