Provider Demographics
NPI:1093746802
Name:KEARNEY, CHARLENE PATTEN (LCSW)
Entity Type:Individual
Prefix:
First Name:CHARLENE
Middle Name:PATTEN
Last Name:KEARNEY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1403 PEMBERTON RD
Mailing Address - Street 2:#306
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23238-4474
Mailing Address - Country:US
Mailing Address - Phone:804-741-7500
Mailing Address - Fax:804-741-7900
Practice Address - Street 1:1403 PEMBERTON RD
Practice Address - Street 2:#306
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23238-4474
Practice Address - Country:US
Practice Address - Phone:804-741-7500
Practice Address - Fax:804-741-7900
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040031651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical