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General NPI Number Information
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NPI Number | 1093422255
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Entity Type | Individual
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Provider Name | JOO HWAN SHIN PSYD
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Gender | Male
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Dates
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Enumeration Date | 10/27/2022
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Last Update Date | 10/27/2022
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Provider Practice Location Address
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Address Line | 1 PARK AVE FL 8
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City | NEW YORK
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State | NY
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Zip | 10016-5802
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Country | US
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Telephone | 412-496-3719
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Fax |
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Provider Business Mailing Address
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Address Line | 15 E 30TH ST APT 32B
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City | NEW YORK
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State | NY
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Zip | 10016-7032
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 025143
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License Number State | NY
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