Healthcare Provider Details

I. General information

NPI: 1083082333
Provider Name (Legal Business Name): ANDREA KERR MHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2015
Last Update Date: 09/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 MOUNT CARMEL PL
POUGHKEEPSIE NY
12601-1714
US

IV. Provider business mailing address

40 ROUTE 216 APT 1
HOPEWELL JUNCTION NY
12533-4337
US

V. Phone/Fax

Practice location:
  • Phone: 845-485-8901
  • Fax:
Mailing address:
  • Phone: 845-800-5468
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberP99249
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: