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General NPI Number Information
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NPI Number | 1184657249
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Entity Type | Individual
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Provider Name | JUDITH E. KIERSKY L.C.S.W., PH.D.
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Gender | Female
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Dates
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Enumeration Date | 07/09/2006
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Last Update Date | 08/20/2007
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Provider Practice Location Address
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Address Line | 160 W END AVE SUITE 11P
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City | NEW YORK
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State | NY
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Zip | 10023-5601
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Country | US
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Telephone | 646-831-1538
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Fax |
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Provider Business Mailing Address
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Address Line | 20 MARIANO RD
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City | SANTA FE
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State | NM
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Zip | 87508-8786
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Country | US
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Telephone | 646-831-1538
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | R0319221
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | I-06516
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License Number State | NM
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