MEDICARE: DR. KRISTINE T. KINGSLEY PSY.D.

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	014708-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	A300037950	OTHER	NY	PTAN

General Provider Information

NPI Number	:	1831221407
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KRISTINE T. KINGSLEY PSY.D.

Provider Business Mailing Address
First Line	:	400 E 34TH ST
Second Line	:	RR 315
City	:	NEW YORK
State	:	NY
Zip	:	10016-4901
Country	:	US
Telephone Number	:	212-263-6177
Fax Number	:

Provider Business Practice Location Address
First Line	:	60 E 42ND ST
Second Line	:	SUITE 4600
City	:	NEW YORK
State	:	NY
Zip	:	10165-0006
Country	:	US
Telephone Number	:	917-716-6995
Fax Number	:

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

Provider Enumeration Date	:	03/09/2007
Last Update Date	:	06/06/2011

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