Provider Demographics
NPI:1598957821
Name:APPELBAUM, KENNETH ANDREW (PHD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:ANDREW
Last Name:APPELBAUM
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 GARFIELD PL
Mailing Address - Street 2:APARTMENT 2L
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-2050
Mailing Address - Country:US
Mailing Address - Phone:718-369-2579
Mailing Address - Fax:
Practice Address - Street 1:18904 UNION TPKE
Practice Address - Street 2:
Practice Address - City:FRESH MEADOWS
Practice Address - State:NY
Practice Address - Zip Code:11366-1862
Practice Address - Country:US
Practice Address - Phone:718-369-2579
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-10
Last Update Date:2007-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY9290103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical