Provider Demographics
NPI:1063294866
Name:MIJIN KIM CREATIVE ARTS THERAPY PSYCHOTHERAPY, PLLC
Entity type:Organization
Organization Name:MIJIN KIM CREATIVE ARTS THERAPY PSYCHOTHERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MIJIN
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:DA, LCAT
Authorized Official - Phone:917-767-5237
Mailing Address - Street 1:21 CAROLYN WAY
Mailing Address - Street 2:
Mailing Address - City:PURDYS
Mailing Address - State:NY
Mailing Address - Zip Code:10578-1011
Mailing Address - Country:US
Mailing Address - Phone:917-767-5237
Mailing Address - Fax:
Practice Address - Street 1:111 N. CENTRAL PARK AVENUE
Practice Address - Street 2:SUITE 340
Practice Address - City:HARTSDALE
Practice Address - State:NY
Practice Address - Zip Code:10530
Practice Address - Country:US
Practice Address - Phone:917-767-5237
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-17
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental HealthGroup - Multi-Specialty