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General NPI Number Information
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NPI Number | 1881683209
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Entity Type | Individual
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Provider Name | KERI MCCONAGHY LICSW
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Gender | Female
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Dates
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Enumeration Date | 10/18/2005
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Last Update Date | 08/01/2018
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Provider Practice Location Address
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Address Line | 235 OCALLAGHAN WAY
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City | LYNN
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State | MA
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Zip | 01905
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Country | US
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Telephone | 781-691-7157
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Fax |
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Provider Business Mailing Address
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Address Line | 32 MERMAID AVE
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City | WINTHROP
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State | MA
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Zip | 02152-1123
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Country | US
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Telephone | 617-335-8877
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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 | 111244
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License Number State | MA
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