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General NPI Number Information
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NPI Number | 1386074268
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Entity Type | Individual
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Provider Name | BERNARD P KINLAN LCSW
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Gender | Male
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Dates
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Enumeration Date | 11/14/2013
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Last Update Date | 11/14/2013
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Provider Practice Location Address
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Address Line | 1 ASCOT LANE TERRACE AT GLEN EDDY
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City | NISKAYUNA
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State | NY
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Zip | 12309
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Country | US
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Telephone | 518-280-8361
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Fax |
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Provider Business Mailing Address
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Address Line | 123 KENNEWYCK CIR
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City | SLINGERLANDS
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State | NY
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Zip | 12159-9564
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Country | US
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Telephone | 518-452-5674
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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 | PRO18167
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License Number State | NY
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