Healthcare Provider Details

I. General information

NPI: 1255909164
Provider Name (Legal Business Name): MS. MARY MARGARET KENIRY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2021
Last Update Date: 07/16/2024
Certification Date: 07/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

327 ABBOTTSFORD ROAD
SCHENECTADY NY
12304
US

IV. Provider business mailing address

1413 BERYL WAY
WATERVLIET NY
12189-2983
US

V. Phone/Fax

Practice location:
  • Phone: 518-381-8911
  • Fax:
Mailing address:
  • Phone: 518-331-2034
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: