Healthcare Provider Details

I. General information

NPI: 1659645406
Provider Name (Legal Business Name): ALYSE MARIE KERR MS NCC NADD-CC LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/25/2012
Last Update Date: 11/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 MULBERRY STREET SUITE 301
SCRANTON PA
18503
US

IV. Provider business mailing address

300 MULBERRY STREET SUITE 301
SCRANTON PA
18503
US

V. Phone/Fax

Practice location:
  • Phone: 570-955-5479
  • Fax: 570-955-5528
Mailing address:
  • Phone: 607-237-7337
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberPC005681
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: