Provider Demographics
NPI:1841471638
Name:KIERNAN, DARIA S (PMHNP)
Entity type:Individual
Prefix:
First Name:DARIA
Middle Name:S
Last Name:KIERNAN
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 BEAR RUN
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06798-3334
Mailing Address - Country:US
Mailing Address - Phone:203-263-4397
Mailing Address - Fax:
Practice Address - Street 1:8 TITUS RD
Practice Address - Street 2:CONNECTICUT THERAPY ASSOCIATES, LLC
Practice Address - City:WASHINGTON DEPOT
Practice Address - State:CT
Practice Address - Zip Code:06794-1517
Practice Address - Country:US
Practice Address - Phone:860-868-0857
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-20
Last Update Date:2012-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003151363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner