Provider Demographics
NPI:1972559490
Name:KEARNS, SANDRA JONES (PHD)
Entity type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:JONES
Last Name:KEARNS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:JEAN
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:20101 SW BIRCH ST
Mailing Address - Street 2:SUITE 130B
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-1759
Mailing Address - Country:US
Mailing Address - Phone:949-910-8213
Mailing Address - Fax:
Practice Address - Street 1:20101 SW BIRCH ST
Practice Address - Street 2:SUITE 130B
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-1759
Practice Address - Country:US
Practice Address - Phone:949-910-8213
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-26
Last Update Date:2010-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 20202103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACP20202Medicare PIN