Provider Demographics
NPI:1316043292
Name:KEARNEY, KEVIN J (PSYD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:J
Last Name:KEARNEY
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 1:322 COCHRAN PL
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11581-3232
Mailing Address - Country:US
Mailing Address - Phone:516-791-7580
Mailing Address - Fax:
Practice Address - Street 1:120 PLANT AVE
Practice Address - Street 2:
Practice Address - City:HAUPPAUGE
Practice Address - State:NY
Practice Address - Zip Code:11788-3805
Practice Address - Country:US
Practice Address - Phone:631-851-3810
Practice Address - Fax:631-273-4342
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014096-1103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYVM7941Medicare ID - Type Unspecified