Provider Demographics
NPI:1316168917
Name:HWANG, JENNY A (PHD)
Entity type:Individual
Prefix:DR
First Name:JENNY
Middle Name:A
Last Name:HWANG
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1050 HALLOCK AVE
Mailing Address - Street 2:
Mailing Address - City:PORT JEFFERSON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11776-1214
Mailing Address - Country:US
Mailing Address - Phone:631-384-8461
Mailing Address - Fax:631-632-9754
Practice Address - Street 1:1050 HALLOCK AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:PORT JEFFERSON STATION
Practice Address - State:NY
Practice Address - Zip Code:11776-1214
Practice Address - Country:US
Practice Address - Phone:631-384-8461
Practice Address - Fax:631-632-9754
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2013-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017067-1103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical