Provider Demographics
NPI:1417530353
Name:MCGUINNESS, KYRSTEN DANIELLE
Entity Type:Individual
Prefix:
First Name:KYRSTEN
Middle Name:DANIELLE
Last Name:MCGUINNESS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:624 TARA OAKS DR
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:OH
Mailing Address - Zip Code:45042-3925
Mailing Address - Country:US
Mailing Address - Phone:513-444-5782
Mailing Address - Fax:
Practice Address - Street 1:3768 WAYNE TRACE RD
Practice Address - Street 2:
Practice Address - City:EATON
Practice Address - State:OH
Practice Address - Zip Code:45320-8412
Practice Address - Country:US
Practice Address - Phone:937-405-5672
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-29
Last Update Date:2021-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.2001375-TRNE104100000X
OHS.2106705104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker