Provider Demographics
NPI:1689742033
Name:DANNETT, KENNETH S (PHD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:S
Last Name:DANNETT
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 1:175 PARROTT RD
Mailing Address - Street 2:
Mailing Address - City:WEST NYACK
Mailing Address - State:NY
Mailing Address - Zip Code:10994-1020
Mailing Address - Country:US
Mailing Address - Phone:845-634-3468
Mailing Address - Fax:
Practice Address - Street 1:175 PARROTT RD
Practice Address - Street 2:
Practice Address - City:WEST NYACK
Practice Address - State:NY
Practice Address - Zip Code:10994-1020
Practice Address - Country:US
Practice Address - Phone:845-634-3468
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY8547103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYV50591Medicare ID - Type UnspecifiedMEDICARE NO. NYC
NYV50592Medicare ID - Type UnspecifiedMEDICARE NO. WEST NYACK