Provider Demographics
NPI:1578763595
Name:KEARNEY, CURTIS (MA LCPC)
Entity Type:Individual
Prefix:
First Name:CURTIS
Middle Name:
Last Name:KEARNEY
Suffix:
Gender:M
Credentials:MA LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1117 ASHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60202-1185
Mailing Address - Country:US
Mailing Address - Phone:847-975-3416
Mailing Address - Fax:847-975-3416
Practice Address - Street 1:1604 CHICAGO AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-6017
Practice Address - Country:US
Practice Address - Phone:847-975-3416
Practice Address - Fax:847-975-3416
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-18
Last Update Date:2012-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180006608101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional