Provider Demographics
NPI:1386122927
Name:CHUM, WILLIAM (MA, LMHC)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:CHUM
Suffix:
Gender:M
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57-18 WOODSIDE AVE
Mailing Address - Street 2:ST 2-102
Mailing Address - City:WOODSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11377
Mailing Address - Country:US
Mailing Address - Phone:212-810-9100
Mailing Address - Fax:
Practice Address - Street 1:57-18 WOODSIDE AVE
Practice Address - Street 2:ST 2-102
Practice Address - City:WOODSIDE
Practice Address - State:NY
Practice Address - Zip Code:11377
Practice Address - Country:US
Practice Address - Phone:718-639-3600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-06
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI744101YM0800X
NY009943101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health