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General NPI Number Information
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NPI Number | 1235807512
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Entity Type | Individual
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Provider Name | STEFANIE ALISON MOYNIHAN KYDES PHD
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Gender | Female
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Dates
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Enumeration Date | 09/01/2021
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Last Update Date | 08/25/2023
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Provider Practice Location Address
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Address Line | 220 BOWEN CT
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City | ANNAPOLIS
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State | MD
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Zip | 21401-1945
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Country | US
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Telephone | 617-943-9640
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Fax |
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Provider Business Mailing Address
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Address Line | 220 BOWEN CT
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City | ANNAPOLIS
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State | MD
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Zip | 21401-1945
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Country | US
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Telephone |
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 07009
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License Number State | MD
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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 | LP03048
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License Number State | KS
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Taxonomy #3
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PY61149309
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License Number State | WA
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