Individual
DR. KYLE PARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PSYD
Contact information
Practice address
220 5TH AVE FL 11, NEW YORK, NY 10001-8017
(347) 470-4704
Mailing address
220 5TH AVE FL 11, NEW YORK, NY 10001-8017
(347) 470-4704
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
024411
NY
103TC0700X
Clinical Psychologist
024411
NY
Other
Enumeration date
07/23/2021
Last updated
12/16/2023
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