Provider Demographics
NPI:1972764934
Name:KEARNS, VICKY YIANNOULIS
Entity type:Individual
Prefix:
First Name:VICKY
Middle Name:YIANNOULIS
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 1:58 SPALLUS RD
Mailing Address - Street 2:
Mailing Address - City:STOUGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02072-2749
Mailing Address - Country:US
Mailing Address - Phone:617-335-3233
Mailing Address - Fax:
Practice Address - Street 1:58 SPALLUS RD
Practice Address - Street 2:
Practice Address - City:STOUGHTON
Practice Address - State:MA
Practice Address - Zip Code:02072-2749
Practice Address - Country:US
Practice Address - Phone:617-335-3233
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-23
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1431106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist