| NPI | 1528583507 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARY NG-TEDJASUKMANA, LCSW, PLLC Psychotherapist/ Life Coach 718-395-2064 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NJ 44SC05712100) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY 081483) |
| Enumeration Date | 2017-08-10 |
| Last Update Date | 2022-07-21 |