Trina Wong, Llc | |
42 Newport Pl Fairfield CT 06825-2536 | |
(203) 671-5836 | |
Not Available |
Full Name | Trina Wong, Llc |
---|---|
Speciality | Marriage & Family Therapist |
Location | 42 Newport Pl, Fairfield, Connecticut |
Authorized Official Name and Position | Trina Wong (OWNER) |
Authorized Official Contact | 2036715836 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
Trina Wong, Llc 42 Newport Pl Fairfield CT 06825-2536 Ph: (203) 671-5836 | Trina Wong, Llc 42 Newport Pl Fairfield CT 06825-2536 Ph: (203) 671-5836 |
NPI Number | 1306331046 |
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Provider Enumeration Date | 06/26/2018 |
Last Update Date | 06/26/2018 |
Medicare PECOS PAC ID | 6901244888 |
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Medicare Enrollment ID | O20240411000798 |
Identifier | Type | State | Issuer |
---|---|---|---|
1306331046 | NPI | - | NPPES |
004069985 | Medicaid | CT |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
106H00000X | Marriage & Family Therapist | 001955 (Connecticut) | Primary |
Provider Name | Trina Wong |
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Provider Type | Practitioner - Marriage And Family Therapist |
Provider Identifiers | NPI Number: 1164936951 PECOS PAC ID: 8729420989 Enrollment ID: I20240603003270 |
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