Provider Demographics
NPI:1407523616
Name:HERR, KYLE ALEXANDER (CRC)
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:ALEXANDER
Last Name:HERR
Suffix:
Gender:M
Credentials:CRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 SURREY LN APT A
Mailing Address - Street 2:
Mailing Address - City:WAPPINGERS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12590-5751
Mailing Address - Country:US
Mailing Address - Phone:914-882-6459
Mailing Address - Fax:
Practice Address - Street 1:5 SURREY LN APT A
Practice Address - Street 2:
Practice Address - City:WAPPINGERS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12590-5751
Practice Address - Country:US
Practice Address - Phone:631-220-0602
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-25
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY488722101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty