Provider Demographics
NPI:1760565733
Name:KINNEY, MICHAEL J (PSY D)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:J
Last Name:KINNEY
Suffix:
Gender:M
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5351 JAYCEE AVE # C
Mailing Address - Street 2:SUITE 1
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17112-2938
Mailing Address - Country:US
Mailing Address - Phone:717-657-2080
Mailing Address - Fax:717-657-2290
Practice Address - Street 1:5351 JAYCEE AVE # C
Practice Address - Street 2:SUITE 1
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17112-2938
Practice Address - Country:US
Practice Address - Phone:717-657-2080
Practice Address - Fax:717-657-2290
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS003438L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
076975GHEMedicare ID - Type Unspecified