Provider Demographics
NPI:1336836196
Name:CHO, JIYON (LMHC)
Entity Type:Individual
Prefix:
First Name:JIYON
Middle Name:
Last Name:CHO
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:
Other - Last Name:CHO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:200 S MIDDLE NECK RD APT C2
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-4626
Mailing Address - Country:US
Mailing Address - Phone:510-703-4055
Mailing Address - Fax:
Practice Address - Street 1:200 S MIDDLE NECK RD APT C2
Practice Address - Street 2:
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-4626
Practice Address - Country:US
Practice Address - Phone:510-703-4055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-21
Last Update Date:2023-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006478-01101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health