Provider Demographics
NPI:1053485425
Name:KERNE, ROBERT MARION (LCSW AND LMFT)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:MARION
Last Name:KERNE
Suffix:
Gender:M
Credentials:LCSW AND LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 N MORRISON BLVD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70401-2312
Mailing Address - Country:US
Mailing Address - Phone:985-351-3237
Mailing Address - Fax:
Practice Address - Street 1:620 N MORRISON BLVD
Practice Address - Street 2:SUITE 4
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70401-2312
Practice Address - Country:US
Practice Address - Phone:985-351-3237
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2017-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA17711041C0700X
LAMFT 905106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2185012Medicaid
LA2185012Medicaid