Jenny Yeeun Park

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

015218 Issued in NY

Practice address

1211 Stewart Ave Ste 100
Bethpage, NY 11714-1601

Phone

(516) 465-3999

NPI assigned

Oct 3, 2024

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Nov 13, 2024 through Nov 13, 2026

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• The Long Island Mental Health Counseling Group, PC

  • Mental Health Counselor
  • Bethpage, NY
  • NPI 1013441401
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1727913600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1727913600000",
    "number": "1194544528",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1211 STEWART AVE STE 100",
            "city": "BETHPAGE",
            "state": "NY",
            "postal_code": "117141601"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1211 STEWART AVE STE 100",
            "city": "BETHPAGE",
            "state": "NY",
            "postal_code": "117141601",
            "telephone_number": "516-465-3999"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARK",
        "first_name": "JENNY",
        "middle_name": "YEEUN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-10-03",
        "last_updated": "2024-10-03",
        "certification_date": "2024-10-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NY",
            "license": "015218",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dzeneta Pajazetovic
• Nicholas John Palagonia, MD
• Frank Michael Palumbo, M.D.
• Lisa Doreen Paolini, MD
• Park Avenue Chiropractic
• Katherine Seonghyeon Park, PHARM D
• Steve Park, M.D.
• Darshil Patel
• Dharav Vipulbhai Patel, M.D.
• Betsy Ann Pathickal, M.D.

• Mental Health Counselor in Bethpage, NY
• Providers in Bethpage, NY by specialty
• Mental Health Counselor in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 3, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.