Provider Demographics
NPI:1922071901
Name:KEARNEY, ROSALIND V (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ROSALIND
Middle Name:V
Last Name:KEARNEY
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:PO BOX 382363
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02238-2363
Mailing Address - Country:US
Mailing Address - Phone:617-491-5685
Mailing Address - Fax:781-605-1932
Practice Address - Street 1:15 STORY ST
Practice Address - Street 2:# 4
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138-4950
Practice Address - Country:US
Practice Address - Phone:617-491-5685
Practice Address - Fax:781-605-1932
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-09
Last Update Date:2008-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6121103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA249037OtherVALUE OPTIONS
MA0501077Medicaid
MA724832OtherTUFTS
MA9102715OtherPHCS
MA403-8964-4OtherHUGHP
MAW04909OtherBCBS MA
MA0501077Medicaid