Provider Demographics
NPI:1487422234
Name:MCCD KS PSYCHIATRY SERVICES PA
Entity type:Organization
Organization Name:MCCD KS PSYCHIATRY SERVICES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIEF MEDICAL OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGIA
Authorized Official - Middle Name:
Authorized Official - Last Name:GAVERAS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:917-309-7915
Mailing Address - Street 1:109 W 27TH ST # 5S
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-6208
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8101 COLLEGE BLVD STE 100
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66210-2671
Practice Address - Country:US
Practice Address - Phone:917-634-5311
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-12
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty