Provider Demographics
NPI:1689632341
Name:KEARNEY, MARIA (PHD, LP)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:KEARNEY
Suffix:
Gender:F
Credentials:PHD, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4544 COUNTRY ROAD 123 STE 134
Mailing Address - Street 2:
Mailing Address - City:ST CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56303
Mailing Address - Country:US
Mailing Address - Phone:320-258-3833
Mailing Address - Fax:320-253-5741
Practice Address - Street 1:4544 COUNTRY ROAD 123 STE 134
Practice Address - Street 2:
Practice Address - City:ST CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303
Practice Address - Country:US
Practice Address - Phone:320-258-3833
Practice Address - Fax:320-253-5741
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN37282084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1012488OtherPREFERRED ONE
MN268J2KEOtherBLUES
MN20287 01OtherBLUES MN
MN167907OtherUCARE
MN6107709OtherMEDICA