Healthcare Provider Details

I. General information

NPI: 1720362825
Provider Name (Legal Business Name): BREANNE E KEARNEY M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2011
Last Update Date: 10/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 CEDAR ST STE 302
NEW ROCHELLE NY
10801-5247
US

IV. Provider business mailing address

19 BRENDAN AVE
MASSAPEQUA PARK NY
11762-3305
US

V. Phone/Fax

Practice location:
  • Phone: 914-576-5292
  • Fax:
Mailing address:
  • Phone: 516-884-0743
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number017014
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: