Provider Demographics
NPI:1023156593
Name:KEARSE, KENNETH (PSYD, LCMHC, CHT)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:
Last Name:KEARSE
Suffix:
Gender:M
Credentials:PSYD, LCMHC, CHT
Other - Prefix:DR
Other - First Name:KAZI
Other - Middle Name:
Other - Last Name:KEARSE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD, LCMHC, CHT
Mailing Address - Street 1:155 BEACH 116TH ST
Mailing Address - Street 2:SUITE 3F
Mailing Address - City:ROCKAWAY PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11694-2413
Mailing Address - Country:US
Mailing Address - Phone:516-375-2869
Mailing Address - Fax:718-474-0368
Practice Address - Street 1:155 BEACH 116TH ST
Practice Address - Street 2:SUITE 3F
Practice Address - City:ROCKAWAY PARK
Practice Address - State:NY
Practice Address - Zip Code:11694-2413
Practice Address - Country:US
Practice Address - Phone:516-375-2869
Practice Address - Fax:718-474-0368
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-04
Last Update Date:2008-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003367101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health