Provider Demographics
NPI:1669564647
Name:KEARNEY, LYNN J (MFT)
Entity type:Individual
Prefix:
First Name:LYNN
Middle Name:J
Last Name:KEARNEY
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:621 MARATHON DR
Mailing Address - Street 2:
Mailing Address - City:CAMPBELL
Mailing Address - State:CA
Mailing Address - Zip Code:95008-0455
Mailing Address - Country:US
Mailing Address - Phone:650-704-1734
Mailing Address - Fax:
Practice Address - Street 1:201 SAN ANTONIO CIR
Practice Address - Street 2:SUITE C125
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:CA
Practice Address - Zip Code:94040-1254
Practice Address - Country:US
Practice Address - Phone:650-513-5556
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 41650106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA358124OtherMENTAL HEALTH NETWORK