Provider Demographics
NPI:1770053357
Name:KEARNS, MOLLY KATHRYN
Entity type:Individual
Prefix:
First Name:MOLLY
Middle Name:KATHRYN
Last Name:KEARNS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8779 SE BAHAMA CIR
Mailing Address - Street 2:
Mailing Address - City:HOBE SOUND
Mailing Address - State:FL
Mailing Address - Zip Code:33455-0000
Mailing Address - Country:US
Mailing Address - Phone:772-260-4352
Mailing Address - Fax:
Practice Address - Street 1:1765 SW CAPTAINS PLACE
Practice Address - Street 2:
Practice Address - City:PALM CITY
Practice Address - State:FL
Practice Address - Zip Code:34990
Practice Address - Country:US
Practice Address - Phone:772-266-8727
Practice Address - Fax:772-494-7093
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-27
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT19-94320106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty