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General NPI Number Information
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NPI Number | 1477163707
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Entity Type | Individual
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Provider Name | KEVIN MCKIERNAN PHD
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Gender | Male
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Dates
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Enumeration Date | 08/02/2020
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Last Update Date | 08/02/2020
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Provider Practice Location Address
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Address Line | 333 WESTCHESTER AVE STE LN02
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City | WHITE PLAINS
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State | NY
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Zip | 10604-2912
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Country | US
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Telephone | 917-538-8932
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Fax | 914-428-4747
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Provider Business Mailing Address
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Address Line | 30 EUCLID AVE
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City | HASTINGS ON HUDSON
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State | NY
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Zip | 10706-1110
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Country | US
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Telephone | 917-538-8932
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Fax | 914-428-4747
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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 | 016936
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License Number State | NY
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