Healthcare Provider Details

I. General information

NPI: 1205866324
Provider Name (Legal Business Name): MARYLOUISE E KERWIN PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 01/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 MULLICA HILL RD ROBINSON HALL
GLASSBORO NJ
08028-1700
US

IV. Provider business mailing address

201 MULLICA HILL RD ROBINSON HALL
GLASSBORO NJ
08028-1700
US

V. Phone/Fax

Practice location:
  • Phone: 856-256-5470
  • Fax: 856-256-4892
Mailing address:
  • Phone: 856-256-5470
  • Fax: 856-256-4892

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPS006790L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number35SI00381100
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License NumberPS006790L
License Number StatePA
# 4
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number35SI00381100
License Number StateNJ
# 5
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License NumberPS006790L
License Number StatePA
# 6
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number35SI00381100
License Number StateNJ
# 7
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number35SI00381100
License Number StateNJ
# 8
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberPS006790L
License Number StatePA
# 9
Primary TaxonomyN
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License NumberPS006790L
License Number StatePA
# 10
Primary TaxonomyN
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License Number35SI00381100
License Number StateNJ
# 11
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number35SI00381100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: