Provider Demographics
NPI:1225658313
Name:GILBERT, KIERNAN CONNOR (PSYD)
Entity Type:Individual
Prefix:
First Name:KIERNAN
Middle Name:CONNOR
Last Name:GILBERT
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 W VISTA AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85021-7253
Mailing Address - Country:US
Mailing Address - Phone:480-828-7747
Mailing Address - Fax:
Practice Address - Street 1:2013 N 36TH ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85008-3026
Practice Address - Country:US
Practice Address - Phone:602-381-6100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-20
Last Update Date:2020-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZPSY-005196103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical