Provider Demographics
NPI:1225357692
Name:KILDARE, STEPHEN BRUCE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:BRUCE
Last Name:KILDARE
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 E 5TH ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:NY
Mailing Address - Zip Code:10553-2115
Mailing Address - Country:US
Mailing Address - Phone:914-667-1128
Mailing Address - Fax:
Practice Address - Street 1:500 E 5TH ST
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:NY
Practice Address - Zip Code:10553-2115
Practice Address - Country:US
Practice Address - Phone:914-667-1128
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-25
Last Update Date:2010-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013783103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist