Provider Demographics
NPI:1417146820
Name:KING, PURIM H (LCSW)
Entity type:Individual
Prefix:
First Name:PURIM
Middle Name:H
Last Name:KING
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 1:17 FURNACE BROOK DR
Mailing Address - Street 2:
Mailing Address - City:CORTLANDT MANOR
Mailing Address - State:NY
Mailing Address - Zip Code:10567-6503
Mailing Address - Country:US
Mailing Address - Phone:914-417-1924
Mailing Address - Fax:203-549-0271
Practice Address - Street 1:27 STRAWBERRY HILL AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06902-2691
Practice Address - Country:US
Practice Address - Phone:914-417-1924
Practice Address - Fax:203-549-0271
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-22
Last Update Date:2013-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY19142101YA0400X
NY079987-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00473038OtherGROUP MEDICAID