Provider Demographics
NPI:1679532014
Name:LERNER, KENNETH G (MD)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:G
Last Name:LERNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:445 CYPRESS STREET
Mailing Address - Street 2:MANCHESTER COUNSELING SERVICES, SUITE 8
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03103
Mailing Address - Country:US
Mailing Address - Phone:603-668-4079
Mailing Address - Fax:603-663-8605
Practice Address - Street 1:445 CYPRESS STREET,
Practice Address - Street 2:MANCHESTER COUNSELING SERVICES SUITE 8
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03103
Practice Address - Country:US
Practice Address - Phone:603-668-4079
Practice Address - Fax:603-663-8605
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH109532084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH794910OtherMVP PIN
NH01Y007645NH01OtherANTHEM ACES #
NH2102931OtherCIGNA BH PIN
NH30201544Medicaid
NH30201544Medicaid
NHRE7931Medicare PIN