Healthcare Provider Details

I. General information

NPI: 1578553772
Provider Name (Legal Business Name): HERSCHEL F KEARNS LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2005
Last Update Date: 10/15/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36977 PARK AVE
BURNEY CA
96013-4067
US

IV. Provider business mailing address

4082 CHERYL DR
REDDING CA
96002-3527
US

V. Phone/Fax

Practice location:
  • Phone: 530-335-5091
  • Fax:
Mailing address:
  • Phone: 530-722-0977
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS11620
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: