Provider Demographics
NPI:1326868209
Name:NGONG, YENLA
Entity type:Individual
Prefix:MISS
First Name:YENLA
Middle Name:
Last Name:NGONG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 NEMASKET PL APT B
Mailing Address - Street 2:
Mailing Address - City:NEW BEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02740-1745
Mailing Address - Country:US
Mailing Address - Phone:404-539-7020
Mailing Address - Fax:
Practice Address - Street 1:3057 ACUSHNET AVE
Practice Address - Street 2:
Practice Address - City:NEW BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02745-3636
Practice Address - Country:US
Practice Address - Phone:508-744-8643
Practice Address - Fax:508-990-0298
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-15
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker