Provider Demographics
NPI:1508539909
Name:KEOUGH, KATHRYN LYON (PHD)
Entity Type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:LYON
Last Name:KEOUGH
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 1:101 E 56TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-2661
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:101 E 56TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-2661
Practice Address - Country:US
Practice Address - Phone:646-452-0665
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-30
Last Update Date:2023-10-18
Deactivation Date:2021-08-02
Deactivation Code:
Reactivation Date:2022-10-12
Provider Licenses
StateLicense IDTaxonomies
NY025803103TB0200X, 103TC2200X
103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral