Provider Demographics
NPI:1689248825
Name:KINARD, JOHN (CASAC)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:
Last Name:KINARD
Suffix:
Gender:M
Credentials:CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9310 AVENUE N
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11236-5265
Mailing Address - Country:US
Mailing Address - Phone:347-985-5500
Mailing Address - Fax:718-613-7564
Practice Address - Street 1:882 BERGEN STREET
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11238-3301
Practice Address - Country:US
Practice Address - Phone:718-613-7510
Practice Address - Fax:718-613-7564
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-13
Last Update Date:2021-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY28618101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)