Provider Demographics
NPI:1518553619
Name:KIM, LYUDMILA EDUARDOVNA (LMSW)
Entity Type:Individual
Prefix:MS
First Name:LYUDMILA
Middle Name:EDUARDOVNA
Last Name:KIM
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 1:231 BERGEN ST # 1
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11217-2210
Mailing Address - Country:US
Mailing Address - Phone:360-627-0332
Mailing Address - Fax:
Practice Address - Street 1:231 BERGEN ST # 1
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11217-2210
Practice Address - Country:US
Practice Address - Phone:360-627-0332
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-14
Last Update Date:2020-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM108650-01104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker