Provider Demographics
NPI:1891196648
Name:PARK, SUNYOUNG
Entity Type:Individual
Prefix:
First Name:SUNYOUNG
Middle Name:
Last Name:PARK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01852-6245
Mailing Address - Country:US
Mailing Address - Phone:978-459-0389
Mailing Address - Fax:978-459-7642
Practice Address - Street 1:35 MARKET ST
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01852-6245
Practice Address - Country:US
Practice Address - Phone:978-459-0389
Practice Address - Fax:978-459-7642
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-11
Last Update Date:2014-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health