Provider Demographics
NPI:1194002295
Name:MYERS, KENNETH E (LCSW)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:E
Last Name:MYERS
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CL # 4655
Mailing Address - Street 2:POBOX 95000
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19195-4665
Mailing Address - Country:US
Mailing Address - Phone:800-444-6020
Mailing Address - Fax:845-256-1881
Practice Address - Street 1:275 7TH AVE RM 2501
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-8400
Practice Address - Country:US
Practice Address - Phone:646-846-9651
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-03
Last Update Date:2019-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY086183104100000X
NY0834031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker