Doctor Name: | TARA MCKERNAN |
NPI Number: | 1306217021 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | ME.D, LCPC-C |
License Number: | XL4551 |
Business Practice Address: | 1 Dewey Street Bar Harbor, ME - 04609 |
Business Phone Number: | 2072883388 |
Business Fax Number: | |
Mailing Address: | Po Box 314, HULLS COVE |
State: | ME |
Postal Code: | 046440314 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 10/08/2015 |
NPI Last Update Date: | 10/08/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | XL4551 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | ME |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |