Provider Demographics
NPI:1568775211
Name:KEARNS, KELLY (PSYD)
Entity Type:Individual
Prefix:DR
First Name:KELLY
Middle Name:
Last Name:KEARNS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2456 HORSESHOE DR
Mailing Address - Street 2:
Mailing Address - City:EAST STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18301-8122
Mailing Address - Country:US
Mailing Address - Phone:630-673-7914
Mailing Address - Fax:973-677-4253
Practice Address - Street 1:101 EISENHOWER PKWY STE 300
Practice Address - Street 2:
Practice Address - City:ROSELAND
Practice Address - State:NJ
Practice Address - Zip Code:07068-1054
Practice Address - Country:US
Practice Address - Phone:630-673-7914
Practice Address - Fax:973-677-4253
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-23
Last Update Date:2022-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ101-A438103G00000X
NJ35SI00484400103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist