=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033638663
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DENNIS P KERR ED.M.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/14/2017
-----------------------------------------------------
Last Update Date | 09/14/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 455 BOOT RD
-----------------------------------------------------
City | DOWNINGTOWN
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19335-3043
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 484-237-5296
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2253 CHANDLER LN
-----------------------------------------------------
City | SCHWENKSVILLE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19473-2417
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-679-2054
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103T00000X
-----------------------------------------------------
Taxonomy Name | Psychologist
-----------------------------------------------------
License Number | PS-003435-L
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------