Provider Demographics
NPI:1336336189
Name:CHUNG, IRENE WAI MING (PHD)
Entity type:Individual
Prefix:PROF
First Name:IRENE
Middle Name:WAI MING
Last Name:CHUNG
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 1:156 5TH AVE
Mailing Address - Street 2:SUITE 718
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-7002
Mailing Address - Country:US
Mailing Address - Phone:917-576-3609
Mailing Address - Fax:212-452-7150
Practice Address - Street 1:156 5TH AVE
Practice Address - Street 2:SUITE 718
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-7002
Practice Address - Country:US
Practice Address - Phone:917-576-3609
Practice Address - Fax:212-452-7150
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-26
Last Update Date:2007-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0223931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical