Healthcare Provider Details

I. General information

NPI: 1144674326
Provider Name (Legal Business Name): JUNE PARK LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2016
Last Update Date: 01/22/2024
Certification Date: 01/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

VIA GIORGIO CORBETTA 17
VICENZA VENETO
36010
IT

IV. Provider business mailing address

CMR 473 BOX 395
APO AE
09606-0004
US

V. Phone/Fax

Practice location:
  • Phone: 44-461-9000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberMSW006730
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW006463
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: