Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TC1900X | Counseling Psychologist | 02811-1 | NY |
NPI | 1083175467 |
---|---|
Provider Name | Dr. Koun Eum |
First Address | Jericho, NY 11753-2127 |
Second Address | Jericho, NY 11753-2127 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/03/2019 |
Last Update Date | 27/03/2019 |