Basic Information
| Provider Information | |||||||||
| NPI: | 1255687588 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JUNG | ||||||||
| FirstName: | KIMBERLY | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MS. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5B BEECH SPRING DR | ||||||||
| Address2: | |||||||||
| City: | SUMMIT | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 079011179 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9085162995 | ||||||||
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| Practice Location | |||||||||
| Address1: | 216 NORTH AVE E | ||||||||
| Address2: | |||||||||
| City: | CRANFORD | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070162473 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9082727500 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/24/2012 | ||||||||
| LastUpdateDate: | 07/24/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 37PC00317400 | NJ | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.