Healthcare Provider Details

I. General information

NPI: 1194877605
Provider Name (Legal Business Name): KENNETH JOSEPH KINDYA PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 05/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1725 CEDAR AVE REAR
SCRANTON PA
18505-1609
US

IV. Provider business mailing address

PO BOX 4255
SCRANTON PA
18505-6255
US

V. Phone/Fax

Practice location:
  • Phone: 207-907-0016
  • Fax:
Mailing address:
  • Phone: 207-907-0016
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPS779
License Number StateME
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPS-016246
License Number StatePA

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: