Healthcare Provider Details

I. General information

NPI: 1841471638
Provider Name (Legal Business Name): DARIA S KIERNAN PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2007
Last Update Date: 03/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 TITUS RD CONNECTICUT THERAPY ASSOCIATES, LLC
WASHINGTON DEPOT CT
06794-1517
US

IV. Provider business mailing address

10 BEAR RUN
WOODBURY CT
06798-3334
US

V. Phone/Fax

Practice location:
  • Phone: 860-868-0857
  • Fax:
Mailing address:
  • Phone: 203-263-4397
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number003151
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: