Individual
DR. PETER LYNN KINGAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
31 OAK ST, 21, PATCHOGUE, NY 11772-2887
(631) 447-6425
(631) 776-8027
Mailing address
31 OAK ST, 21, PATCHOGUE, NY 11772-2887
(631) 447-6425
(631) 776-8027
Taxonomy
Speciality
Code
Description
License number
State
103TC1900X
Counseling Psychologist
Primary
0011037
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01386290
—
NY
01
—
Y042249
CHAMPUS/CHAMPVA
NY
Enumeration date
08/31/2006
Last updated
07/08/2007
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