MEDICARE: DR. LOIS S KERN BA MSW PHD

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	101YM0800X	Mental Health Counselor	SW14464
2	1041C0700X	Clinical Social Worker	SW14464	NJ
3	1041C0700X	Clinical Social Worker	SW14464
4	221700000X	Art Therapist	SW14464

General Provider Information

NPI Number	:	1770704595
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LOIS S KERN BA MSW PHD

Provider Business Mailing Address
First Line	:	PO BOX 0891
Second Line	:	KABBALAH NISSIONARY PHYS SW GROUP
City	:	STATEN ISLAND
State	:	NY
Zip	:	10314-0891
Country	:	US
Telephone Number	:	718-720-0292
Fax Number	:	718-761-5562

Provider Business Practice Location Address
First Line	:	800 MANOR ROAD
Second Line	:	PROFESSIONAL SUITES #2V KABBALAH MISSRY PHYS SW GROUP
City	:	STATEN ISLAND
State	:	NY
Zip	:	10314-7016
Country	:	US
Telephone Number	:	347-613-7836
Fax Number	:	718-761-5562

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

Provider Enumeration Date	:	05/01/2007
Last Update Date	:	09/11/2025

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