Provider Demographics
NPI:1992756415
Name:KINNEY, ANDREW (PH D)
Entity type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:
Last Name:KINNEY
Suffix:
Gender:M
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 OVERBROOK CREST
Mailing Address - Street 2:
Mailing Address - City:NEW HARTFORD
Mailing Address - State:NY
Mailing Address - Zip Code:31413
Mailing Address - Country:US
Mailing Address - Phone:315-527-0922
Mailing Address - Fax:315-223-8890
Practice Address - Street 1:23 OXFORD RD
Practice Address - Street 2:
Practice Address - City:NEW HARTFORD
Practice Address - State:NY
Practice Address - Zip Code:13413-2638
Practice Address - Country:US
Practice Address - Phone:315-223-8889
Practice Address - Fax:315-223-8890
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014019103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02302514Medicaid
NY6164642OtherUNITED BEHAVIORAL HEALTH
NY050502000004OtherFIDELIS
NY164399OtherCDPH VALUE OPTIONS ID #
NYHEALTH NOWOther000919601002
NYS14019-4BOtherWORKMENS COMPENSATION
NY109999OtherBC/BS PIN #
NY415038OtherMVP PROVIDER ID #
NY7336676OtherVALUE OPTIONS GHI #
NYP16034Medicare UPIN
NYCC2603Medicare ID - Type UnspecifiedMEDICARE PROVIDER #