Provider Demographics
NPI:1629285200
Name:KISHNER, JEFFREY M (LMHC)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:M
Last Name:KISHNER
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:82 NASSAU ST # 60397
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10038-3703
Mailing Address - Country:US
Mailing Address - Phone:347-394-7841
Mailing Address - Fax:
Practice Address - Street 1:135 PROSPECT PARK W
Practice Address - Street 2:APT. 14
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-4267
Practice Address - Country:US
Practice Address - Phone:347-423-4631
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003751-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health