Healthcare Provider Details

I. General information

NPI: 1093746802
Provider Name (Legal Business Name): CHARLENE PATTEN KEARNEY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1403 PEMBERTON RD #306
RICHMOND VA
23238-4474
US

IV. Provider business mailing address

1403 PEMBERTON RD #306
RICHMOND VA
23238-4474
US

V. Phone/Fax

Practice location:
  • Phone: 804-741-7500
  • Fax: 804-741-7900
Mailing address:
  • Phone: 804-741-7500
  • Fax: 804-741-7900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904003165
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: