Doctor Name: | KRYSTLE LEE KENYON |
NPI Number: | 1699182220 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | M.S.E.D |
License Number: | |
Business Practice Address: | 38 Abbott Ave Mastic, NY - 119501533 |
Business Phone Number: | 6319269358 |
Business Fax Number: | |
Mailing Address: | 38 Abbott Ave, MASTIC |
State: | NY |
Postal Code: | 11950 |
Phone Number: | 6319269358 |
Fax Number: | |
NPI Enumeration Date: | 07/15/2014 |
NPI Last Update Date: | 07/15/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TS0200X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | School |
Taxonomy Definition: |