Provider Demographics
NPI:1245313238
Name:VICKERS, KAY HALKINS (PHD)
Entity type:Individual
Prefix:DR
First Name:KAY
Middle Name:HALKINS
Last Name:VICKERS
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 1:45 N STATION PLZ
Mailing Address - Street 2:SUITE311
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-5011
Mailing Address - Country:US
Mailing Address - Phone:515-482-4548
Mailing Address - Fax:516-676-6362
Practice Address - Street 1:45 N STATION PLZ
Practice Address - Street 2:SUITE311
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-5011
Practice Address - Country:US
Practice Address - Phone:515-482-4548
Practice Address - Fax:516-676-6362
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004371103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYV21181Medicare ID - Type Unspecified