Individual
DR. KEVIN JOSEPH NISSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
79 MIDDLEVILLE RD, NORTHPORT, NY 11768-2200
(631) 261-4400
Mailing address
PO BOX 34, HOLTSVILLE, NY 11742-0034
(631) 578-9526
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
—
—
Other
Enumeration date
01/30/2024
Last updated
01/30/2024
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