MEDICARE: KERI MCCONAGHY 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	111244	MA

General Provider Information

NPI Number	:	1881683209
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KERI MCCONAGHY LICSW

Provider Business Mailing Address
First Line	:	32 MERMAID AVE
Second Line	:
City	:	WINTHROP
State	:	MA
Zip	:	02152-1123
Country	:	US
Telephone Number	:	617-335-8877
Fax Number	:

Provider Business Practice Location Address
First Line	:	235 OCALLAGHAN WAY
Second Line	:
City	:	LYNN
State	:	MA
Zip	:	01905
Country	:	US
Telephone Number	:	781-691-7157
Fax Number	:

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

Provider Enumeration Date	:	10/18/2005
Last Update Date	:	08/01/2018

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