Provider Demographics
NPI:1861721383
Name:KONG, SONGEUI (LCSW)
Entity type:Individual
Prefix:
First Name:SONGEUI
Middle Name:
Last Name:KONG
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:SONGEUI
Other - Middle Name:
Other - Last Name:KWON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:11439 TAIPEI CT FL 2
Mailing Address - Street 2:
Mailing Address - City:COLLEGE POINT
Mailing Address - State:NY
Mailing Address - Zip Code:11356-1576
Mailing Address - Country:US
Mailing Address - Phone:718-670-5562
Mailing Address - Fax:
Practice Address - Street 1:14601 45TH AVE STE 310
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-2281
Practice Address - Country:US
Practice Address - Phone:718-670-5562
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-11
Last Update Date:2016-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0825021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical