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General NPI Number Information
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NPI Number | 1194965970
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Entity Type | Individual
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Provider Name | GEORGE KINGSLEY PH.D.
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Gender | Male
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Dates
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Enumeration Date | 03/06/2009
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Last Update Date | 10/30/2023
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Provider Practice Location Address
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Address Line | 345 7TH AVE STE 1601F
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City | NEW YORK
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State | NY
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Zip | 10001-5006
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Country | US
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Telephone | 917-282-8025
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Fax |
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Provider Business Mailing Address
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Address Line | 345 7TH AVE STE 1601F
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City | NEW YORK
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State | NY
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Zip | 10001-5006
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Country | US
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Telephone | 917-282-8025
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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 | 070791
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 019130
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License Number State | NY
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