Provider Demographics
NPI:1851873731
Name:LEE-PARK, SUN YOUNG (LCSW)
Entity Type:Individual
Prefix:MS
First Name:SUN YOUNG
Middle Name:
Last Name:LEE-PARK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:SUNNY
Other - Middle Name:
Other - Last Name:LEE-PARK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1441 FLAT ROCK RD
Mailing Address - Street 2:
Mailing Address - City:PENN VALLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19072-1239
Mailing Address - Country:US
Mailing Address - Phone:703-623-0895
Mailing Address - Fax:
Practice Address - Street 1:1441 FLAT ROCK RD
Practice Address - Street 2:
Practice Address - City:PENN VALLEY
Practice Address - State:PA
Practice Address - Zip Code:19072
Practice Address - Country:US
Practice Address - Phone:703-623-0895
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-06
Last Update Date:2018-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0187831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical