Healthcare Provider Details

I. General information

NPI: 1518034974
Provider Name (Legal Business Name): KERRY LEAH MCKEE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 05/12/2020
Certification Date: 05/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3021 TELEGRAPH AVE STE C
BERKELEY CA
94705-2072
US

IV. Provider business mailing address

3021 TELEGRAPH AVE STE C
BERKELEY CA
94705-2072
US

V. Phone/Fax

Practice location:
  • Phone: 510-221-3183
  • Fax:
Mailing address:
  • Phone: 510-221-3183
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number24979
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: