Provider Demographics
NPI:1013799352
Name:HALL, KIERSTAN RUTH (PSYD)
Entity Type:Individual
Prefix:DR
First Name:KIERSTAN
Middle Name:RUTH
Last Name:HALL
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 ROCKAWAY ST
Mailing Address - Street 2:
Mailing Address - City:ISLIP TERRACE
Mailing Address - State:NY
Mailing Address - Zip Code:11752-1017
Mailing Address - Country:US
Mailing Address - Phone:516-497-0512
Mailing Address - Fax:
Practice Address - Street 1:1563 MONTAUK HWY
Practice Address - Street 2:
Practice Address - City:OAKDALE
Practice Address - State:NY
Practice Address - Zip Code:11769-1322
Practice Address - Country:US
Practice Address - Phone:631-563-3162
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-20
Last Update Date:2023-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026083103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist