MEDICARE: DR. JONATHAN KRIEGER PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	010040	NY
2	103TC2200X	Clinical Child & Adolescent Psychologist	010040	NY

General Provider Information

NPI Number	:	1396964094
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JONATHAN KRIEGER PHD

Provider Business Mailing Address
First Line	:	75 SHARON LANE
Second Line	:
City	:	KINGSTON
State	:	NY
Zip	:	12401-4440
Country	:	US
Telephone Number	:	845-339-5075
Fax Number	:

Provider Business Practice Location Address
First Line	:	401 MAIN STREET
Second Line	:	ROSENDALE FAMILY THERAPY CENTER
City	:	ROSENDALE
State	:	NY
Zip	:	12472-0202
Country	:	US
Telephone Number	:	845-658-9760
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/24/2007
Last Update Date	:	08/07/2008

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