Provider Demographics
NPI:1598418659
Name:KIM, BOKYUNG (LMSW)
Entity Type:Individual
Prefix:
First Name:BOKYUNG
Middle Name:
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 1:247 S BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:NYACK
Mailing Address - State:NY
Mailing Address - Zip Code:10960-4114
Mailing Address - Country:US
Mailing Address - Phone:609-694-0381
Mailing Address - Fax:
Practice Address - Street 1:118 JACLYN DR
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13205-3263
Practice Address - Country:US
Practice Address - Phone:929-279-2773
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-30
Last Update Date:2022-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY100767104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker