Provider Demographics
NPI:1922214139
Name:KISHINEVSKY, VERA (PHD)
Entity Type:Individual
Prefix:
First Name:VERA
Middle Name:
Last Name:KISHINEVSKY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:186 W 80TH ST
Mailing Address - Street 2:SUITE 5J
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-6317
Mailing Address - Country:US
Mailing Address - Phone:646-852-7594
Mailing Address - Fax:
Practice Address - Street 1:186 W 80TH ST
Practice Address - Street 2:SUITE 5J
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-6317
Practice Address - Country:US
Practice Address - Phone:646-852-7594
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015193-1103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY015193-1OtherLICENSE NUMBER