Doctor Name: | LISA KEARNS |
NPI Number: | 1013362003 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | IMF91866 |
Business Practice Address: | 1670 S Amphlett Blvd Suite 115 San Mateo, CA - 944022510 |
Business Phone Number: | 6503497969 |
Business Fax Number: | 6503491103 |
Mailing Address: | 320 Bridge Rd, HILLSBOROUGH |
State: | CA |
Postal Code: | 940106912 |
Phone Number: | 6503497969 |
Fax Number: | 6503491103 |
NPI Enumeration Date: | 04/27/2016 |
NPI Last Update Date: | 04/27/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | IMF91866 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |