Provider Demographics
NPI:1811234123
Name:PARK, JEE HYUN (MA LCADC)
Entity Type:Individual
Prefix:MRS
First Name:JEE
Middle Name:HYUN
Last Name:PARK
Suffix:
Gender:F
Credentials:MA LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:25 ELIZABETH ST
Mailing Address - Street 2:SUITE F
Mailing Address - City:NEW BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08901-3497
Mailing Address - Country:US
Mailing Address - Phone:484-213-1075
Mailing Address - Fax:732-246-3455
Practice Address - Street 1:25 ELIZABETH ST
Practice Address - Street 2:SUITE F
Practice Address - City:NEW BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08901-3497
Practice Address - Country:US
Practice Address - Phone:484-213-1075
Practice Address - Fax:732-246-3455
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-07
Last Update Date:2013-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC00177100101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)