Healthcare Provider Details

I. General information

NPI: 1194031674
Provider Name (Legal Business Name): MELISSA PEARL KINER PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/23/2010
Last Update Date: 10/24/2023
Certification Date: 10/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

535 S OYSTER BAY RD
PLAINVIEW NY
11803-3310
US

IV. Provider business mailing address

450 FRANK ST
OCEANSIDE NY
11572-2813
US

V. Phone/Fax

Practice location:
  • Phone: 516-888-4357
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License NumberP77142
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number025228-01
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: