MEDICARE: KERMINDRA L MABERRY LCSW

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	12866	LA

General Provider Information

NPI Number	:	1972956530
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KERMINDRA L MABERRY LCSW

Provider Business Mailing Address
First Line	:	61540 BENNETT RD
Second Line	:
City	:	AMITE
State	:	LA
Zip	:	70422-4356
Country	:	US
Telephone Number	:	985-474-4958
Fax Number	:	985-318-7617

Provider Business Practice Location Address
First Line	:	61540 BENNETT RD
Second Line	:
City	:	AMITE
State	:	LA
Zip	:	70422-4356
Country	:	US
Telephone Number	:	985-474-4958
Fax Number	:

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

Provider Enumeration Date	:	07/19/2016
Last Update Date	:	12/08/2025

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