Provider Demographics
NPI:1275631541
Name:KEARNEY, ANNE B (PHD)
Entity Type:Individual
Prefix:DR
First Name:ANNE
Middle Name:B
Last Name:KEARNEY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 CARMEN CIR
Mailing Address - Street 2:
Mailing Address - City:MEDFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:02052-2801
Mailing Address - Country:US
Mailing Address - Phone:508-359-6180
Mailing Address - Fax:
Practice Address - Street 1:7 CARMEN CIR
Practice Address - Street 2:
Practice Address - City:MEDFIELD
Practice Address - State:MA
Practice Address - Zip Code:02052-2801
Practice Address - Country:US
Practice Address - Phone:508-359-6180
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6049103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW05074Medicare ID - Type UnspecifiedPSYCHOLOGIST