Provider Demographics
NPI:1013362003
Name:KEARNS, LISA
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:KEARNS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:HILLSBOROUGH
Mailing Address - State:CA
Mailing Address - Zip Code:94010-6912
Mailing Address - Country:US
Mailing Address - Phone:650-349-7969
Mailing Address - Fax:650-349-1103
Practice Address - Street 1:1670 S AMPHLETT BLVD
Practice Address - Street 2:SUITE 115
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94402-2510
Practice Address - Country:US
Practice Address - Phone:650-349-7969
Practice Address - Fax:650-349-1103
Is Sole Proprietor?:No
Enumeration Date:2016-04-27
Last Update Date:2016-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF91866101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health