=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972689602
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SOOKNAM CHOO LCSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/27/2006
-----------------------------------------------------
Last Update Date | 01/24/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7814 ROOSEVELT AVE 204
-----------------------------------------------------
City | JACKSON HEIGHTS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11372-6626
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-899-8918
-----------------------------------------------------
Fax | 718-426-2219
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 253 SOUTH ST
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10002-7827
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-720-4564
-----------------------------------------------------
Fax | 212-732-9297
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 079219-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------