Provider Demographics
NPI:1649249889
Name:KIM, SUE H (PHD)
Entity type:Individual
Prefix:DR
First Name:SUE
Middle Name:H
Last Name:KIM
Suffix:
Gender:F
Credentials:PHD
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 844
Mailing Address - Street 2:ONE CHALET DRIVE, SUITE 106
Mailing Address - City:WILTON
Mailing Address - State:NH
Mailing Address - Zip Code:03086-0844
Mailing Address - Country:US
Mailing Address - Phone:603-654-2181
Mailing Address - Fax:603-654-2182
Practice Address - Street 1:ONE CHALET DR STE 106
Practice Address - Street 2:THE SUMMIT EXECUTIVE OFFICES
Practice Address - City:WILTON
Practice Address - State:NH
Practice Address - Zip Code:03086-0844
Practice Address - Country:US
Practice Address - Phone:603-654-2181
Practice Address - Fax:603-654-2182
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2010-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NHLP955103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30424604Medicaid
NHRE615801OtherMEDICARE PTAN
OTH000Medicare UPIN