Healthcare Provider Details

I. General information

NPI: 1598739765
Provider Name (Legal Business Name): M ELYCE KEARNS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/15/2006
Last Update Date: 05/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 BROOK ST STE 25D
SCITUATE MA
02066
US

IV. Provider business mailing address

61 WARREN AVE
MARSHFIELD MA
02050-1600
US

V. Phone/Fax

Practice location:
  • Phone: 781-561-6860
  • Fax: 855-326-8994
Mailing address:
  • Phone: 617-216-6364
  • Fax: 855-326-8994

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number75462
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number75462
License Number StateMA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier3138488
Identifier TypeMEDICAID
Identifier StateMA
Identifier Issuer
# 2
Identifier075462
Identifier TypeOTHER
Identifier StateMA
Identifier IssuerTUFTS HEALTH PLAN
# 3
IdentifierJ16118
Identifier TypeOTHER
Identifier StateMA
Identifier IssuerBCBS MA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: