Provider Demographics
NPI:1184865313
Name:KIM LEHNERT, PSYCHOLOGY, PH.D., PLLC
Entity Type:Organization
Organization Name:KIM LEHNERT, PSYCHOLOGY, PH.D., PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KIM
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:LEHNERT
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:631-974-1443
Mailing Address - Street 1:224 LIBERTY AVE
Mailing Address - Street 2:
Mailing Address - City:PORT JEFFERSON
Mailing Address - State:NY
Mailing Address - Zip Code:11777-2010
Mailing Address - Country:US
Mailing Address - Phone:631-974-1443
Mailing Address - Fax:
Practice Address - Street 1:701 ROUTE 25A STE A3
Practice Address - Street 2:
Practice Address - City:MOUNT SINAI
Practice Address - State:NY
Practice Address - Zip Code:11766-2050
Practice Address - Country:US
Practice Address - Phone:631-328-5930
Practice Address - Fax:631-675-1338
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-18
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013596261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center