MEDICARE: NANCY AXON KERRIGAN LICSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	111484-SW-LICSW	MA

General Provider Information

NPI Number	:	1700361599
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NANCY AXON KERRIGAN LICSW

Provider Business Mailing Address
First Line	:	PO BOX 997
Second Line	:
City	:	EAST FALMOUTH
State	:	MA
Zip	:	02536-0997
Country	:	US
Telephone Number	:	508-548-5382
Fax Number	:

Provider Business Practice Location Address
First Line	:	12 QUASHNET WAY
Second Line	:
City	:	EAST FALMOUTH
State	:	MA
Zip	:	02536-7735
Country	:	US
Telephone Number	:	508-548-5382
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/27/2018
Last Update Date	:	09/27/2018

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Directions to “ NANCY AXON KERRIGAN LICSW” Practice Location

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