Provider Demographics
NPI:1497832299
Name:PETER A KINNEY
Entity type:Organization
Organization Name:PETER A KINNEY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:A
Authorized Official - Last Name:KINNEY
Authorized Official - Suffix:
Authorized Official - Credentials:EDD
Authorized Official - Phone:508-339-2400
Mailing Address - Street 1:44 WOOD AVE
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:02048-1255
Mailing Address - Country:US
Mailing Address - Phone:508-339-2400
Mailing Address - Fax:508-339-2440
Practice Address - Street 1:44 WOOD AVE
Practice Address - Street 2:BLDG 2 SUITE 8
Practice Address - City:MANSFIELD
Practice Address - State:MA
Practice Address - Zip Code:02048-1255
Practice Address - Country:US
Practice Address - Phone:508-339-2400
Practice Address - Fax:508-339-2440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2010-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA327103TH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth ServiceGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW01187OtherBCBS
MAW10091OtherBCBS
MA708966OtherTUFTS
MAW10091OtherBCBS
MAW10091Medicare ID - Type Unspecified