Basic Information
| Provider Information | |||||||||
| NPI: | 1154344331 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KERN | ||||||||
| FirstName: | MICHELE | ||||||||
| MiddleName: | JOY | ||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | KERN-ZINKOVITCH | ||||||||
| OtherFirstName: | MICHELE | ||||||||
| OtherMiddleName: | JOY | ||||||||
| OtherNamePrefix: | |||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 5222 S MAIN ST | ||||||||
| Address2: | |||||||||
| City: | MUNNSVILLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 134094059 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3154955732 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 138 NORTH COURT ST. | ||||||||
| Address2: | |||||||||
| City: | WAMPSVILLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 13163 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3153662327 | ||||||||
| FaxNumber: | 3153662599 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/26/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 003051-1 | NY | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.