Healthcare Provider Details

I. General information

NPI: 1427225143
Provider Name (Legal Business Name): KERI THOMAS LICSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KERI ANN FARRELL LICSW

II. Dates (important events)

Enumeration Date: 05/12/2008
Last Update Date: 03/16/2023
Certification Date: 03/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39 BOYLSTON ST
BOSTON MA
02116-4702
US

IV. Provider business mailing address

204 HAMPTON DR
VENICE CA
90291-2623
US

V. Phone/Fax

Practice location:
  • Phone: 617-654-1258
  • Fax:
Mailing address:
  • Phone: 310-293-3468
  • Fax: 310-392-8402

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberASW28761
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLC50079829
License Number StateDC
# 3
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904012617
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: