Provider Demographics
NPI:1235336801
Name:KIERNAN, BRIAN (PHD)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:
Last Name:KIERNAN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 CARRSBROOK DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22901-1004
Mailing Address - Country:US
Mailing Address - Phone:540-332-8007
Mailing Address - Fax:
Practice Address - Street 1:128 OAKLAND FARM WAY
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:VA
Practice Address - Zip Code:22947
Practice Address - Country:US
Practice Address - Phone:434-293-9059
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-28
Last Update Date:2010-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810002196103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical