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Heesoo Karina Kim

Counselor

Behavioral Health & Social Service Providers

36 West 25th Street, 10th Floor, New York, NY 10010

PECOS Enrollment

This provider is enrolled in PECOS as HEESOO KIM.

Based on the most recent information from CMS, provider Heesoo Karina Kim is legally eligible to order and refer claims for Part B and DME services only.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Not Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Not Enrolled

CMS last updated its PECOS records today at 9:42 AM.

Profile Details

Provider ID
1144452749
Provider Type
Individual
Full Name
Kim, Heesoo Karina
Credential
LCSW-R, PHD

Gender
Female
Sole Proprietor
Yes
Enumeration Date
8/14/2009
Last Updated
10/16/2015

Contact Information

Practice Location

36 West 25th Street, 10th Floor, New York, NY 10010

(917) 447-8159

Mailing Location

133 N Maple Avenue, #101, East Orange, NJ 07017

(917) 447-8159

Provider Taxonomies

Code	Description	License
Code 101YM0800X Primary	Description Counselor Behavioral Health & Social Service Providers	License R063025 New York
Code 101YM0800X	Description Counselor Behavioral Health & Social Service Providers	License 44SC05455900 New Jersey

Provider Identifiers

ID	Description	Issuer
ID 00063025	Description Medicaid	Issuer Unlisted New York

Heesoo Karina Kim

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Code

Description

License

Provider Identifiers

ID

Description

Issuer

ID

Description

Issuer

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Ahuja, Mehar

Grossman, Elise F.

Koren, Leslie

Corre, Angela Marie

Glerum, Kayla

Kaluski, Ruth Marilyn

Weinstein, Beth D.

Kavish, Naomi

Sands, Michael