Provider Demographics
NPI:1023486610
Name:MEEHAN, KIMBERLY
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:MEEHAN
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 1:18 E 41ST ST
Mailing Address - Street 2:FL 14 C/O LINA
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10017-6244
Mailing Address - Country:US
Mailing Address - Phone:401-864-7253
Mailing Address - Fax:
Practice Address - Street 1:18 E 41ST ST
Practice Address - Street 2:FL 14 C/O LINA
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-6244
Practice Address - Country:US
Practice Address - Phone:646-434-8958
Practice Address - Fax:979-987-3062
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-13
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY4023302084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty