Healthcare Provider Details

I. General information

NPI: 1629553714
Provider Name (Legal Business Name): KERI ASHLEY COY LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2018
Last Update Date: 09/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

67 WALKER LN
FREMONT NH
03044-3527
US

IV. Provider business mailing address

67 WALKER LN
FREMONT NH
03044-3527
US

V. Phone/Fax

Practice location:
  • Phone: 603-512-8274
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number115511
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: