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General NPI Number Information
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NPI Number | 1740878305
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Entity Type | Individual
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Provider Name | KERRY ANN BLODGETT LICSW
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Gender | Female
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Dates
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Enumeration Date | 01/08/2021
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Last Update Date | 01/08/2021
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Provider Practice Location Address
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Address Line | 269 TREBLE COVE RD
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City | NORTH BILLERICA
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State | MA
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Zip | 01862-2830
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Country | US
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Telephone | 978-932-3365
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Fax | 978-932-3576
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Provider Business Mailing Address
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Address Line | 85 TENNIS PLAZA RD UNIT 11
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City | DRACUT
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State | MA
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Zip | 01826-3390
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Country | US
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Telephone | 781-258-6428
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 119041
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License Number State | MA
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