Provider Demographics
NPI:1528406667
Name:KERN, MARC F (PHD)
Entity Type:Individual
Prefix:
First Name:MARC
Middle Name:F
Last Name:KERN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:226 S BEVERLY DR
Mailing Address - Street 2:SUITE 225
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90212-3817
Mailing Address - Country:US
Mailing Address - Phone:888-532-9137
Mailing Address - Fax:888-739-6925
Practice Address - Street 1:226 S BEVERLY DR
Practice Address - Street 2:SUITE 225
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90212-3817
Practice Address - Country:US
Practice Address - Phone:888-532-9137
Practice Address - Fax:888-739-6925
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-11
Last Update Date:2013-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY8246103T00000X, 103TA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)