Healthcare Provider Details

I. General information

NPI: 1427681568
Provider Name (Legal Business Name): KERRI CAROSELLI M.S. ED.S
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/18/2020
Last Update Date: 10/09/2024
Certification Date: 10/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 CHASE AVE
NEW CASTLE DE
19720-1236
US

IV. Provider business mailing address

5 REVERE DR STE 120
NORTHBROOK IL
60062-8005
US

V. Phone/Fax

Practice location:
  • Phone: 302-429-4000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number265111
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: