Provider Demographics
NPI:1699805044
Name:KIERNAN, BRENDAN JOSEPH (PSYD DOCTOR OF PSYCH)
Entity type:Individual
Prefix:DR
First Name:BRENDAN
Middle Name:JOSEPH
Last Name:KIERNAN
Suffix:
Gender:M
Credentials:PSYD DOCTOR OF PSYCH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 32957
Mailing Address - Street 2:
Mailing Address - City:JUNEAU
Mailing Address - State:AK
Mailing Address - Zip Code:99803-2957
Mailing Address - Country:US
Mailing Address - Phone:907-723-6041
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 32957
Practice Address - Street 2:
Practice Address - City:JUNEAU
Practice Address - State:AK
Practice Address - Zip Code:99803-2957
Practice Address - Country:US
Practice Address - Phone:907-723-6041
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2024-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK506103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK506OtherLIC PSYCHOLOGIST