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General NPI Number Information
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NPI Number | 1144800194
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Entity Type | Organization
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Legal Business Name | PARK PSYCHOLOGY PLLC
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Dates
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Enumeration Date | 04/13/2021
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Last Update Date | 04/13/2021
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Provider Practice Location Address
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Address Line | 1115 BROADWAY FL 12
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City | NEW YORK
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State | NY
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Zip | 10010-3452
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Country | US
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Telephone | 646-504-3596
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Fax |
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Provider Business Mailing Address
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Address Line | 1115 BROADWAY FL 12
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City | NEW YORK
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State | NY
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Zip | 10010-3452
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Country | US
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Telephone | 646-504-3596
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. PAUL J PARK
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Credential | PSYD
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Telephone | 646-504-3596
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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