Provider Demographics
NPI:1093044554
Name:KEARNEY, ANGELA J
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:J
Last Name:KEARNEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:J
Other - Last Name:FLETCHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 24397
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93002-4397
Mailing Address - Country:US
Mailing Address - Phone:805-652-0596
Mailing Address - Fax:
Practice Address - Street 1:1065 E MAIN ST
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93001-3027
Practice Address - Country:US
Practice Address - Phone:805-652-0596
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-12
Last Update Date:2009-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health