Provider Demographics
NPI:1538442710
Name:KONG, STEPHEN W (DMIN)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:W
Last Name:KONG
Suffix:
Gender:M
Credentials:DMIN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14606 HOLLY AVE
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-2247
Mailing Address - Country:US
Mailing Address - Phone:646-229-3563
Mailing Address - Fax:
Practice Address - Street 1:13605 SANFORD AVE APT 1M
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-3118
Practice Address - Country:US
Practice Address - Phone:646-229-3563
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-23
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001274106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist