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General NPI Number Information
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NPI Number | 1982140091
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Entity Type | Individual
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Provider Name | SOH PARK
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Gender | Female
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Dates
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Enumeration Date | 01/12/2017
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Last Update Date | 08/13/2025
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Provider Practice Location Address
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Address Line | 7529 STANDISH PL STE 355
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City | ROCKVILLE
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State | MD
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Zip | 20855-2733
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Country | US
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Telephone | 301-444-5001
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Fax |
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Provider Business Mailing Address
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Address Line | 5760 BENSALEM BLVD
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City | BENSALEM
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State | PA
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Zip | 19020-3326
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Country | US
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Telephone | 410-713-9102
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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 | 1-16-23954
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-16-23954
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License Number State | MD
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