Provider Demographics
NPI:1437876661
Name:KILEY, MARYANNE (LP)
Entity Type:Individual
Prefix:
First Name:MARYANNE
Middle Name:
Last Name:KILEY
Suffix:
Gender:F
Credentials:LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 RANDOLPH AVE
Mailing Address - Street 2:
Mailing Address - City:CAPE CHARLES
Mailing Address - State:VA
Mailing Address - Zip Code:23310-3209
Mailing Address - Country:US
Mailing Address - Phone:917-733-2038
Mailing Address - Fax:
Practice Address - Street 1:37 E 28TH ST RM 408
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-7919
Practice Address - Country:US
Practice Address - Phone:917-733-2038
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-27
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001154102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst