Provider Demographics
NPI:1649548959
Name:KEARNEY, ELIZABETH M (LCSW)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:M
Last Name:KEARNEY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 9TH ST # 100.164
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92374-4412
Mailing Address - Country:US
Mailing Address - Phone:951-415-3462
Mailing Address - Fax:
Practice Address - Street 1:301 9TH ST # 100.164
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92374-4412
Practice Address - Country:US
Practice Address - Phone:951-415-3462
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-01
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW 30584101YM0800X
CA724941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health