Provider Demographics
NPI:1073738134
Name:KIERNAN, RALPH JOSEPH (PHD)
Entity type:Individual
Prefix:
First Name:RALPH
Middle Name:JOSEPH
Last Name:KIERNAN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:RALPH
Other - Middle Name:
Other - Last Name:MARGOLIES-KIERNAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:200 MIDDLEFIELD RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MENLO PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94025-4002
Mailing Address - Country:US
Mailing Address - Phone:650-324-8565
Mailing Address - Fax:650-324-8565
Practice Address - Street 1:200 MIDDLEFIELD RD
Practice Address - Street 2:SUITE 100
Practice Address - City:MENLO PARK
Practice Address - State:CA
Practice Address - Zip Code:94025-4002
Practice Address - Country:US
Practice Address - Phone:650-324-8565
Practice Address - Fax:650-324-8565
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY4151103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000PL41510Medicare ID - Type Unspecified