Healthcare Provider Details

I. General information

NPI: 1770704595
Provider Name (Legal Business Name): LOIS S KERN BA MSW PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LOIS SOUTH BROOKS BA MSW PHD

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 MANOR ROAD PROFESSIONAL SUITES #2V KABBALAH MISSRY PHYS SW GROUP
STATEN ISLAND NY
10314-7016
US

IV. Provider business mailing address

PO BOX 0891 KABBALAH NISSIONARY PHYS SW GROUP
STATEN ISLAND NY
10314-0891
US

V. Phone/Fax

Practice location:
  • Phone: 347-613-7836
  • Fax: 718-761-5562
Mailing address:
  • Phone: 718-720-0292
  • Fax: 718-761-5562

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberSW14464
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW14464
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW14464
License Number State
# 4
Primary TaxonomyY
Taxonomy Code221700000X
TaxonomyArt Therapist
License NumberSW14464
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: