Basic Information
| Provider Information | |||||||||
| NPI: | 1639368194 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KIM | ||||||||
| FirstName: | CYNTHIA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | LCSW | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | KERNAHAN | ||||||||
| OtherFirstName: | CYNTHIA | ||||||||
| OtherMiddleName: | |||||||||
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| OtherCredential: | LMSW | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 279 MAIN ST | ||||||||
| Address2: | SUITE 204 | ||||||||
| City: | NEW PALTZ | ||||||||
| State: | NY | ||||||||
| PostalCode: | 125611623 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8452553046 | ||||||||
| FaxNumber: | 8452550236 | ||||||||
| Practice Location | |||||||||
| Address1: | 1 FAMILY PRACTICE DR | ||||||||
| Address2: | SUITE 3 | ||||||||
| City: | KINGSTON | ||||||||
| State: | NY | ||||||||
| PostalCode: | 124016449 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8453382562 | ||||||||
| FaxNumber: | 8453388909 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/22/2007 | ||||||||
| LastUpdateDate: | 12/16/2010 | ||||||||
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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 | 1041C0700X | 077703 | NY | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.