Provider Demographics
NPI:1598739765
Name:KEARNS, M ELYCE (MD)
Entity Type:Individual
Prefix:DR
First Name:M
Middle Name:ELYCE
Last Name:KEARNS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:61 WARREN AVE
Mailing Address - Street 2:
Mailing Address - City:MARSHFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:02050-1600
Mailing Address - Country:US
Mailing Address - Phone:617-216-6364
Mailing Address - Fax:855-326-8994
Practice Address - Street 1:4 BROOK ST STE 25D
Practice Address - Street 2:
Practice Address - City:SCITUATE
Practice Address - State:MA
Practice Address - Zip Code:02066
Practice Address - Country:US
Practice Address - Phone:781-561-6860
Practice Address - Fax:855-326-8994
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-15
Last Update Date:2018-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA754622084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3138488Medicaid
MA075462OtherTUFTS HEALTH PLAN
MAJ16118OtherBCBS MA
MAJ16118OtherBCBS MA
G10959Medicare UPIN