Provider Demographics
NPI:1588400097
Name:SLATTERY, KIERAN THOMAS (MA)
Entity type:Individual
Prefix:
First Name:KIERAN
Middle Name:THOMAS
Last Name:SLATTERY
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 FERNE BOULEVARD
Mailing Address - Street 2:APT 4
Mailing Address - City:DREXEL HILL
Mailing Address - State:PA
Mailing Address - Zip Code:19026
Mailing Address - Country:US
Mailing Address - Phone:717-695-1034
Mailing Address - Fax:
Practice Address - Street 1:545 BECKETT RD STE 207
Practice Address - Street 2:
Practice Address - City:SWEDESBORO
Practice Address - State:NJ
Practice Address - Zip Code:08085-1512
Practice Address - Country:US
Practice Address - Phone:856-467-1000
Practice Address - Fax:856-467-1150
Is Sole Proprietor?:No
Enumeration Date:2024-07-03
Last Update Date:2024-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor