Provider Demographics
NPI:1457422446
Name:KEARNS, JEREMIAH HENRY (LMHC LADAC)
Entity Type:Individual
Prefix:
First Name:JEREMIAH
Middle Name:HENRY
Last Name:KEARNS
Suffix:
Gender:M
Credentials:LMHC LADAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:556 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HAMPSTEAD
Mailing Address - State:NH
Mailing Address - Zip Code:03841-2077
Mailing Address - Country:US
Mailing Address - Phone:603-329-5420
Mailing Address - Fax:
Practice Address - Street 1:556 MAIN ST
Practice Address - Street 2:
Practice Address - City:HAMPSTEAD
Practice Address - State:NH
Practice Address - Zip Code:03841-2077
Practice Address - Country:US
Practice Address - Phone:603-329-5420
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH308101YA0400X
NH153101YM0800X
MA4152101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30420600Medicaid