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NPI Code Detail

MEDICARE: MS. JEAN KERR LCSW

MEDICARE: MS. JEAN KERR LCSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health CounselorLCSW-2879AZ

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1003912205
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. JEAN KERR LCSW
Provider Business Mailing Address
First Line : 4747 N 7TH ST STE 100
Second Line :
City : PHOENIX
State : AZ
Zip : 85014-3654
Country : US
Telephone Number : 602-279-7655
Fax Number : 602-253-8891
Provider Business Practice Location Address
First Line : 880 N COLORADO ST
Second Line :
City : GILBERT
State : AZ
Zip : 85233-3419
Country : US
Telephone Number : 480-820-0825
Fax Number : 480-820-7863
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/15/2006
Last Update Date : 08/16/2022

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