| Doctor Name: | DR. KENNETH KEARSE |
| NPI Number: | 1023156593 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PSY.D, LCMHC, CHT |
| License Number: | 003367 |
| Business Practice Address: | 155 Beach 116th St Suite 3f Rockaway Park, NY - 116942413 |
| Business Phone Number: | 5163752869 |
| Business Fax Number: | 7184740368 |
| Mailing Address: | 155 Beach 116th St, Suite 3f ROCKAWAY PARK |
| State: | NY |
| Postal Code: | 116942413 |
| Phone Number: | 5163752869 |
| Fax Number: | 7184740368 |
| NPI Enumeration Date: | 02/04/2007 |
| NPI Last Update Date: | 08/05/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | 003367 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |