Provider Demographics
NPI:1033731831
Name:PARK, KIM J (LMSW)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:J
Last Name:PARK
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 UNION ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10940-4906
Mailing Address - Country:US
Mailing Address - Phone:845-343-5556
Mailing Address - Fax:
Practice Address - Street 1:16 UNION ST
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10940-4906
Practice Address - Country:US
Practice Address - Phone:845-343-8100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-14
Last Update Date:2021-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker