Basic Information
| Provider Information | |||||||||
| NPI: | 1770209793 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KINNANE | ||||||||
| FirstName: | CECELIA | ||||||||
| MiddleName: | MCNALLY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 301 W 107TH ST | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100252729 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4046807777 | ||||||||
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| Practice Location | |||||||||
| Address1: | 10470 QUEENS BLVD FL 2 | ||||||||
| Address2: | |||||||||
| City: | FOREST HILLS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 113753638 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7182756010 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/12/2022 | ||||||||
| LastUpdateDate: | 10/12/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/12/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 117284-01 | NY | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.