Provider Demographics
NPI:1194965970
Name:KINGSLEY, GEORGE (PHD)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:
Last Name:KINGSLEY
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 1:345 7TH AVE STE 1601F
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-5006
Mailing Address - Country:US
Mailing Address - Phone:917-282-8025
Mailing Address - Fax:
Practice Address - Street 1:345 7TH AVE STE 1601F
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-5006
Practice Address - Country:US
Practice Address - Phone:917-282-8025
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-06
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0707911041C0700X
NY019130103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical