Provider Demographics
NPI:1073159521
Name:SUZANNE C. KEARNEY LICSW, INC.
Entity Type:Organization
Organization Name:SUZANNE C. KEARNEY LICSW, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICIAN
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:C
Authorized Official - Last Name:KEARNEY
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:617-413-6711
Mailing Address - Street 1:38 COLONIAL AVE
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02460-1215
Mailing Address - Country:US
Mailing Address - Phone:617-413-6711
Mailing Address - Fax:617-332-7991
Practice Address - Street 1:38 COLONIAL AVE
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02460-1215
Practice Address - Country:US
Practice Address - Phone:617-413-6711
Practice Address - Fax:617-332-7991
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-20
Last Update Date:2019-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty