Provider Demographics
NPI:1902152283
Name:KEARNEY, MEGAN JEANNE (BS SP ED)
Entity type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:JEANNE
Last Name:KEARNEY
Suffix:
Gender:F
Credentials:BS SP ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:619 E PARK AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11561-2512
Mailing Address - Country:US
Mailing Address - Phone:516-581-7153
Mailing Address - Fax:516-897-8203
Practice Address - Street 1:619 E PARK AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:NY
Practice Address - Zip Code:11561-2512
Practice Address - Country:US
Practice Address - Phone:516-581-7153
Practice Address - Fax:516-897-8203
Is Sole Proprietor?:No
Enumeration Date:2012-07-24
Last Update Date:2012-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist