Provider Demographics
NPI:1821791344
Name:KIERNAN, LAURA BETH
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:BETH
Last Name:KIERNAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:666 GREENWICH ST APT 539
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10014-6343
Mailing Address - Country:US
Mailing Address - Phone:914-703-2853
Mailing Address - Fax:
Practice Address - Street 1:192 THROOP AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11206-5334
Practice Address - Country:US
Practice Address - Phone:929-210-9333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-23
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health