Individual
DR. KENNETH ALLEN BLANK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PSY.D.
Contact information
Practice address
755 NEW YORK AVE, SUITE 200, HUNTINGTON, NY 11743-4240
(631) 385-1358
Mailing address
47 WOODBURY RD, HAUPPAUGE, NY 11788-4729
(631) 385-1358
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
013740
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01938045
—
NY
Enumeration date
12/11/2006
Last updated
07/08/2007
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