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General NPI Number Information
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NPI Number | 1164118949
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Entity Type | Organization
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Legal Business Name | CLEAR PATH PSYCHOLOGICAL SERVICES, PLLC
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Dates
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Enumeration Date | 04/13/2023
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Last Update Date | 04/13/2023
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Provider Practice Location Address
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Address Line | 24930 VAN ZANDT AVE
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City | LITTLE NECK
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State | NY
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Zip | 11362-1734
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Country | US
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Telephone | 646-820-5829
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Fax |
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Provider Business Mailing Address
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Address Line | 24930 VAN ZANDT AVE
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City | LITTLE NECK
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State | NY
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Zip | 11362-1734
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Country | US
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Telephone | 646-820-5829
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | LUCY KIM
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Credential | PSY.D.
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Telephone | 646-820-5829
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent 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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