Provider Demographics
NPI:1609975564
Name:FIELD, KEVIN STEWART (PHD)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:STEWART
Last Name:FIELD
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 N FRANKLIN ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WATKINS GLEN
Mailing Address - State:NY
Mailing Address - Zip Code:14891-1273
Mailing Address - Country:US
Mailing Address - Phone:607-535-4288
Mailing Address - Fax:607-535-4288
Practice Address - Street 1:221 N FRANKLIN ST
Practice Address - Street 2:SUITE 200
Practice Address - City:WATKINS GLEN
Practice Address - State:NY
Practice Address - Zip Code:14891-1273
Practice Address - Country:US
Practice Address - Phone:607-535-4288
Practice Address - Fax:607-535-4288
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013897103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYCC1563Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER