Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | PSY8246 | CA |
Y | 103T00000X | Psychologist | PSY8246 | CA |
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | PSY8246 | CA |
NPI | 1528406667 |
---|---|
Provider Name | Marc F. Kern |
First Address | Beverly Hills, CA 90212-3817 |
Second Address | Beverly Hills, CA 90212-3817 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/06/2013 |
Last Update Date | 11/06/2013 |