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General NPI Number Information
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NPI Number | 1427820398
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Entity Type | Individual
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Provider Name | MIN KYOUNG PARK JOHNSON LCSW
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Gender | Female
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Dates
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Enumeration Date | 10/24/2023
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Last Update Date | 10/14/2025
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Provider Practice Location Address
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Address Line | 130 W KINGSBRIDGE RD
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City | BRONX
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State | NY
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Zip | 10468-3904
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Country | US
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Telephone | 551-424-4788
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Fax |
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Provider Business Mailing Address
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Address Line | 1658 MAPLE ST
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City | FORT LEE
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State | NJ
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Zip | 07024-2535
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Country | US
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Telephone | 551-424-4788
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 44SC06567100
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 44SL06663300
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License Number State | NJ
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 100810
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License Number State | NY
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Taxonomy #4
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 112895
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License Number State | NY
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