Healthcare Provider Details

I. General information

NPI: 1336208271
Provider Name (Legal Business Name): KATHLEEN KERN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 10/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 S BEVERLY DR SUITE 203
BEVERLY HILLS CA
90212-3827
US

IV. Provider business mailing address

205 S BEVERLY DR SUITE 203
BEVERLY HILLS CA
90212-3827
US

V. Phone/Fax

Practice location:
  • Phone: 949-929-0770
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number18516
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number27531
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: