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NPI Code Detail

MEDICARE: DR. MARIE G. KERNS PSY.D

MEDICARE: DR. MARIE G. KERNS PSY.D
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YP2500XProfessional CounselorMFC 50443CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
145-2358183OTHERCATAX ID #

General Provider Information

NPI Number : 1033489356
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MARIE G. KERNS PSY.D
Provider Business Mailing Address
First Line : 4199 CAMPUS DR STE 550
Second Line :
City : IRVINE
State : CA
Zip : 92612-4694
Country : US
Telephone Number : 949-285-5199
Fax Number :
Provider Business Practice Location Address
First Line : 4199 CAMPUS DR STE 550
Second Line :
City : IRVINE
State : CA
Zip : 92612-4694
Country : US
Telephone Number : 949-285-5199
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/03/2012
Last Update Date : 01/03/2012

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