Provider Demographics
NPI:1437729480
Name:KIM, JENNIFER S
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:S
Last Name:KIM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 BROMPTON RD APT 1E
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-3466
Mailing Address - Country:US
Mailing Address - Phone:516-765-5343
Mailing Address - Fax:
Practice Address - Street 1:37 BROMPTON RD APT 1E
Practice Address - Street 2:
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-3466
Practice Address - Country:US
Practice Address - Phone:516-765-5343
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-30
Last Update Date:2021-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty