MEDICARE: MR. PAUL LIAM KIERNAN LADC

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
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	0895	NH

General Provider Information

NPI Number	:	1679917447
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. PAUL LIAM KIERNAN LADC

Provider Business Mailing Address
First Line	:	82 B RUMFOD
Second Line	:
City	:	CONCORD
State	:	NH
Zip	:	03301
Country	:	US
Telephone Number	:	603-706-0336
Fax Number	:

Provider Business Practice Location Address
First Line	:	25 COUNTRY CLUB RD UNIT 705
Second Line	:
City	:	GILFORD
State	:	NH
Zip	:	03249-6977
Country	:	US
Telephone Number	:	603-706-0336
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/24/2013
Last Update Date	:	04/24/2013

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