Healthcare Provider Details

I. General information

NPI: 1053485425
Provider Name (Legal Business Name): ROBERT MARION KERNE LCSW AND LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 09/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 N MORRISON BLVD SUITE 4
HAMMOND LA
70401-2312
US

IV. Provider business mailing address

620 N MORRISON BLVD SUITE 4
HAMMOND LA
70401-2312
US

V. Phone/Fax

Practice location:
  • Phone: 985-351-3237
  • Fax:
Mailing address:
  • Phone: 985-351-3237
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1771
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFT 905
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: