Provider Demographics
NPI:1538036090
Name:KIDD, MAUREEN JUDE (MSN- PMHNP)
Entity type:Individual
Prefix:
First Name:MAUREEN
Middle Name:JUDE
Last Name:KIDD
Suffix:
Gender:F
Credentials:MSN- PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1540 PELHAM PKWY S APT 3H
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-1110
Mailing Address - Country:US
Mailing Address - Phone:347-968-5347
Mailing Address - Fax:
Practice Address - Street 1:1540 PELHAM PKWY S APT 3H
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-1110
Practice Address - Country:US
Practice Address - Phone:347-968-5347
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-20
Last Update Date:2025-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT199407363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health