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General NPI Number Information
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NPI Number | 1639314008
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Entity Type | Individual
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Provider Name | KIRKLAND C VAUGHANS
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Gender | Male
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Dates
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Enumeration Date | 12/12/2008
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Last Update Date | 12/12/2008
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Provider Practice Location Address
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Address Line | 1840 UNION BLVD
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City | BAY SHORE
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State | NY
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Zip | 11706-7932
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Country | US
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Telephone | 631-647-7885
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Fax | 631-647-7885
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Provider Business Mailing Address
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Address Line | 66 LINCOLN AVE
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City | WYANDANCH
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State | NY
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Zip | 11798-4202
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Country | US
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Telephone | 631-643-0615
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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 | 010404-1
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License Number State | NY
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