Provider Demographics
NPI:1326100983
Name:KIND, DEEANNE DOZIER (PHD)
Entity Type:Individual
Prefix:
First Name:DEEANNE
Middle Name:DOZIER
Last Name:KIND
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:73 BUFF RD
Mailing Address - Street 2:
Mailing Address - City:TENAFLY
Mailing Address - State:NJ
Mailing Address - Zip Code:07670-1453
Mailing Address - Country:US
Mailing Address - Phone:201-568-0656
Mailing Address - Fax:
Practice Address - Street 1:123 W 79TH ST
Practice Address - Street 2:PH 2
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-6480
Practice Address - Country:US
Practice Address - Phone:212-579-5814
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011186103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02012366Medicaid
NY02012366Medicaid