Basic Information
| Provider Information | |||||||||
| NPI: | 1013575554 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KANG | ||||||||
| FirstName: | MISEON | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | LCAT, ATR-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | BROOKLYN PSYCHOTHERAPY | ||||||||
| Address2: | 705 MANHATTAN AVENUE | ||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 11222 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3474748464 | ||||||||
| FaxNumber: | 3976300519 | ||||||||
| Practice Location | |||||||||
| Address1: | BROOKLYN PSYCHOTHERAPY | ||||||||
| Address2: | 148 WILSON AVE | ||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 11237 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3474748464 | ||||||||
| FaxNumber: | 3476300519 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/30/2019 | ||||||||
| LastUpdateDate: | 06/05/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 221700000X | LCAT000594-1 | NY | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Art Therapist |
No ID Information.