Provider Demographics
NPI:1760057491
Name:KIM, JIN HEE (LCSW)
Entity Type:Individual
Prefix:
First Name:JIN HEE
Middle Name:
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:PO BOX 983
Mailing Address - Street 2:
Mailing Address - City:KILLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05751-0983
Mailing Address - Country:US
Mailing Address - Phone:646-232-8909
Mailing Address - Fax:
Practice Address - Street 1:163 VETERANS DRIVE
Practice Address - Street 2:
Practice Address - City:WHITE RIVER JUNCTION
Practice Address - State:VT
Practice Address - Zip Code:05009-0001
Practice Address - Country:US
Practice Address - Phone:802-295-9363
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-25
Last Update Date:2021-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT089.01252671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical