Provider Demographics
NPI:1215680749
Name:CHOI, MINA KIM (LMFT)
Entity type:Individual
Prefix:MS
First Name:MINA
Middle Name:KIM
Last Name:CHOI
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 MOUNT EBO RD N UNIT 633
Mailing Address - Street 2:
Mailing Address - City:BREWSTER
Mailing Address - State:NY
Mailing Address - Zip Code:10509-7655
Mailing Address - Country:US
Mailing Address - Phone:917-620-2806
Mailing Address - Fax:
Practice Address - Street 1:103 SCENIC RIDGE DR
Practice Address - Street 2:
Practice Address - City:BREWSTER
Practice Address - State:NY
Practice Address - Zip Code:10509-4302
Practice Address - Country:US
Practice Address - Phone:917-620-2806
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-03
Last Update Date:2022-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001773-01106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist