Individual
JONATHAN JAME WONG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PMHNP-BC
Contact information
Practice address
3900 LOCH RAVEN BLVD, BALTIMORE, MD 21218-2108
(410) 605-7000
Mailing address
3021 CARLEE RUN CT, ELLICOTT CITY, MD 21042-2158
(631) 974-1688
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
806394
NY
163W00000X
Registered Nurse
R269240
MD
163W00000X
Registered Nurse
Primary
RN726222
PA
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
405708
NY
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
R269240
MD
Other
Enumeration date
01/26/2020
Last updated
01/12/2026
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