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NPI Code Detail

MEDICARE: JOONJOA PARK LCSW

MEDICARE: JOONJOA PARK LCSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker101088NY
2104100000XSocial Worker110291NY

General Provider Information

NPI Number : 1912501347
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOONJOA PARK LCSW
Provider Business Mailing Address
First Line : 125 WALKER ST FL 2
Second Line :
City : NEW YORK
State : NY
Zip : 10013-4135
Country : US
Telephone Number : 212-226-8866
Fax Number : 212-226-2289
Provider Business Practice Location Address
First Line : 13626 37TH AVE
Second Line :
City : FLUSHING
State : NY
Zip : 11354-6533
Country : US
Telephone Number : 718-886-7373
Fax Number : 718-661-6035
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/25/2020
Last Update Date : 04/19/2026

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