Provider Demographics
NPI:1013575554
Name:KANG, MISEON (LCAT, ATR-BC)
Entity Type:Individual
Prefix:MS
First Name:MISEON
Middle Name:
Last Name:KANG
Suffix:
Gender:F
Credentials:LCAT, ATR-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BROOKLYN PSYCHOTHERAPY
Mailing Address - Street 2:705 MANHATTAN AVENUE
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11222
Mailing Address - Country:US
Mailing Address - Phone:347-474-8464
Mailing Address - Fax:397-630-0519
Practice Address - Street 1:BROOKLYN PSYCHOTHERAPY
Practice Address - Street 2:148 WILSON AVE
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11237
Practice Address - Country:US
Practice Address - Phone:347-474-8464
Practice Address - Fax:347-630-0519
Is Sole Proprietor?:No
Enumeration Date:2019-05-30
Last Update Date:2019-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
NYLCAT000594-1221700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health