Healthcare Provider Details

I. General information

NPI: 1235761958
Provider Name (Legal Business Name): KELLIE GEVON MCFARLANE PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/11/2020
Last Update Date: 02/11/2020
Certification Date: 02/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

LINCOLN HOSPITAL, CHILD ADOLESCENT PSYCHIATRIC SERVICES 234 EAST 149TH STREET, FLOOR 4A, ROOM 4-83
BRONX NY
10451
US

IV. Provider business mailing address

1686 PARK PL APT 1B
BROOKLYN NY
11233-4539
US

V. Phone/Fax

Practice location:
  • Phone: 718-579-5156
  • Fax: 718-578-5556
Mailing address:
  • Phone: 917-860-8598
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberP103936
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: