Provider Demographics
NPI:1306217021
Name:MCKERNAN, TARA (MED, LCPC-C)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:MCKERNAN
Suffix:
Gender:F
Credentials:MED, LCPC-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 314
Mailing Address - Street 2:
Mailing Address - City:HULLS COVE
Mailing Address - State:ME
Mailing Address - Zip Code:04644-0314
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1 DEWEY STREET
Practice Address - Street 2:
Practice Address - City:BAR HARBOR
Practice Address - State:ME
Practice Address - Zip Code:04609
Practice Address - Country:US
Practice Address - Phone:207-288-3388
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-08
Last Update Date:2015-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEXL4551101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional