Individual
BON HA GU
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
24302 NORTHERN BLVD, LITTLE NECK, NY 11362-1150
(718) 423-6200
Mailing address
24302 NORTHERN BLVD, LITTLE NECK, NY 11362-1199
(718) 423-6200
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
097774
NY
1041C0700X
Clinical Social Worker
Primary
090339
NY
Other
Enumeration date
10/02/2018
Last updated
12/28/2020
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