Provider Demographics
NPI:1154404333
Name:IM, YOON (LCSW)
Entity type:Individual
Prefix:
First Name:YOON
Middle Name:
Last Name:IM
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:213 WEST WALK
Mailing Address - Street 2:
Mailing Address - City:WEST HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06516-5962
Mailing Address - Country:US
Mailing Address - Phone:203-483-6860
Mailing Address - Fax:203-483-6049
Practice Address - Street 1:94 N BRANFORD RD
Practice Address - Street 2:
Practice Address - City:BRANFORD
Practice Address - State:CT
Practice Address - Zip Code:06405-2811
Practice Address - Country:US
Practice Address - Phone:203-483-6860
Practice Address - Fax:203-483-6049
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0052461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical