Healthcare Provider Details

I. General information

NPI: 1609763200
Provider Name (Legal Business Name): YOUNOK DUMORTIER SHIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2025
Last Update Date: 08/28/2025
Certification Date: 08/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 ROUTE 31 N # 203
PENNINGTON NJ
08534-1606
US

IV. Provider business mailing address

1289 ROUTE 38
HAINESPORT NJ
08036-2730
US

V. Phone/Fax

Practice location:
  • Phone: 609-267-5656
  • Fax:
Mailing address:
  • Phone: 609-669-1267
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number37AC00875600
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number37AC00875600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: