Healthcare Provider Details

I. General information

NPI: 1700675139
Provider Name (Legal Business Name): SOYOUNG PARK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2025
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 HUDSON ST FL 21
JERSEY CITY NJ
07302-3929
US

IV. Provider business mailing address

1830 DELANCEY PL
BRONX NY
10462-3602
US

V. Phone/Fax

Practice location:
  • Phone: 201-896-7171
  • Fax:
Mailing address:
  • Phone: 929-609-0132
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number018066
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: