Provider Demographics
NPI:1356400964
Name:GANEY, KEVIN RUSSELL (PSYD)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:RUSSELL
Last Name:GANEY
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:660 NEWTOWN YARDLEY RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:NEWTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18940-1759
Mailing Address - Country:US
Mailing Address - Phone:215-860-2525
Mailing Address - Fax:215-860-3868
Practice Address - Street 1:660 NEWTOWN YARDLEY RD
Practice Address - Street 2:SUITE 201
Practice Address - City:NEWTOWN
Practice Address - State:PA
Practice Address - Zip Code:18940-1759
Practice Address - Country:US
Practice Address - Phone:215-860-2525
Practice Address - Fax:215-860-3868
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-08
Last Update Date:2011-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS016131103TC0700X, 103TC2200X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent