Provider Demographics
NPI:1962945501
Name:KERINS, CHRISTINE MULLANEY (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:MULLANEY
Last Name:KERINS
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:MARY
Other - Last Name:MULLANEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:165 BROWN PL
Mailing Address - Street 2:ROOM 314
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10454-4110
Mailing Address - Country:US
Mailing Address - Phone:171-829-2546
Mailing Address - Fax:
Practice Address - Street 1:165 BROWN PL
Practice Address - Street 2:ROOM 314
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10454-4110
Practice Address - Country:US
Practice Address - Phone:171-829-2546
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-30
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021781235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist