Provider Demographics
NPI:1376678524
Name:FONG-CHANG, MAY (LCSW)
Entity type:Individual
Prefix:MRS
First Name:MAY
Middle Name:
Last Name:FONG-CHANG
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 943
Mailing Address - Street 2:
Mailing Address - City:ROSEMEAD
Mailing Address - State:CA
Mailing Address - Zip Code:91770-0943
Mailing Address - Country:US
Mailing Address - Phone:626-307-0724
Mailing Address - Fax:
Practice Address - Street 1:1370 VALLEY VISTA DR STE 104
Practice Address - Street 2:
Practice Address - City:DIAMOND BAR
Practice Address - State:CA
Practice Address - Zip Code:91765-3950
Practice Address - Country:US
Practice Address - Phone:909-860-2166
Practice Address - Fax:909-860-5424
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2008-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS177321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical