Provider Demographics
NPI:1679749527
Name:HEANEY, KEVIN-BARRY (LCSW/CASAC)
Entity type:Individual
Prefix:MR
First Name:KEVIN-BARRY
Middle Name:
Last Name:HEANEY
Suffix:
Gender:M
Credentials:LCSW/CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 W 107TH ST APT 2C
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-3041
Mailing Address - Country:US
Mailing Address - Phone:212-749-4453
Mailing Address - Fax:212-523-8057
Practice Address - Street 1:230 W 107TH ST APT 2C
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-3041
Practice Address - Country:US
Practice Address - Phone:212-749-4453
Practice Address - Fax:212-523-8057
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-01
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR24613-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical