Provider Demographics
NPI:1285017079
Name:KIM, LINA HYUN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:LINA
Middle Name:HYUN
Last Name:KIM
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 GREEN STREET
Mailing Address - Street 2:APT B203
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11222
Mailing Address - Country:US
Mailing Address - Phone:917-501-9503
Mailing Address - Fax:
Practice Address - Street 1:42-16 162ND STREET
Practice Address - Street 2:2ND FLOOR
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11358-2688
Practice Address - Country:US
Practice Address - Phone:718-366-9540
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-30
Last Update Date:2021-09-08
Deactivation Date:2021-08-23
Deactivation Code:
Reactivation Date:2021-09-02
Provider Licenses
StateLicense IDTaxonomies
NY095572104100000X
NY0900671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker