MEDICARE: KIERNAN CONNOR GILBERT PSY.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	PSY-005196	AZ

General Provider Information

NPI Number	:	1225658313
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIERNAN CONNOR GILBERT PSY.D.

Provider Business Mailing Address
First Line	:	201 W VISTA AVE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85021-7253
Country	:	US
Telephone Number	:	480-828-7747
Fax Number	:

Provider Business Practice Location Address
First Line	:	2013 N 36TH ST
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85008-3026
Country	:	US
Telephone Number	:	602-381-6100
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/20/2020
Last Update Date	:	04/20/2020

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