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General NPI Number Information
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NPI Number | 1568214583
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Entity Type | Individual
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Provider Name | WILLIAM PARK
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Gender | Male
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Dates
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Enumeration Date | 04/03/2024
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Last Update Date | 04/03/2024
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Provider Practice Location Address
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Address Line | 223 BEDFORD AVE STE A-1025
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City | BROOKLYN
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State | NY
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Zip | 11211-4171
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Country | US
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Telephone | 212-287-7979
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Fax |
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Provider Business Mailing Address
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Address Line | 5042 44TH ST APT 3
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City | WOODSIDE
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State | NY
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Zip | 11377-7389
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Country | US
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Telephone | 917-584-3131
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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