Provider Demographics
NPI:1023615747
Name:WONG, WINNIE MING (MS, LCAT, BC-DMT)
Entity type:Individual
Prefix:MS
First Name:WINNIE
Middle Name:MING
Last Name:WONG
Suffix:
Gender:F
Credentials:MS, LCAT, BC-DMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 CROWN ST APT D18
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11225-2121
Mailing Address - Country:US
Mailing Address - Phone:240-888-4594
Mailing Address - Fax:
Practice Address - Street 1:451 CLARKSON AVE R BUILDING
Practice Address - Street 2:IDD/MH UNIT, R5WEST
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203
Practice Address - Country:US
Practice Address - Phone:718-245-6815
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-06
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002092225600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225600000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDance Therapist