Healthcare Provider Details

I. General information

NPI: 1750899928
Provider Name (Legal Business Name): KIMBERLY CAHALAN LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/22/2018
Last Update Date: 09/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 FRONT ST STE 100
HEMPSTEAD NY
11550-3602
US

IV. Provider business mailing address

14 FRONT ST STE 100
HEMPSTEAD NY
11550-3602
US

V. Phone/Fax

Practice location:
  • Phone: 516-320-3436
  • Fax:
Mailing address:
  • Phone: 163-203-4365
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number006784-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: