Healthcare Provider Details

I. General information

NPI: 1972176063
Provider Name (Legal Business Name): KERI HERLAN PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2021
Last Update Date: 05/21/2024
Certification Date: 05/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

282 WASHINGTON ST
HARTFORD CT
06106-3322
US

IV. Provider business mailing address

38 WOODLAND DR
CHESHIRE CT
06410-1675
US

V. Phone/Fax

Practice location:
  • Phone: 860-837-9700
  • Fax: 860-837-9701
Mailing address:
  • Phone: 585-507-5351
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY11143
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number8.004412
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: