MEDICARE: A GOOD PLACE THERAPY BY KERRIE MOHR, LCSW, PC

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

General Provider Information

NPI Number	:	1982297008
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	A GOOD PLACE THERAPY BY KERRIE MOHR, LCSW, PC

Provider Business Mailing Address
First Line	:	225 BROADWAY STE 2070
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10007-3001
Country	:	US
Telephone Number	:	212-227-4343
Fax Number	:

Provider Business Practice Location Address
First Line	:	2485 CLAY ST STE 104
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94115-1874
Country	:	US
Telephone Number	:	415-329-2882
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MS. KERRIE ANN MOHR
Credential	:	LCSW
Telephone Number	:	212-227-4343

Provider Enumeration Date	:	02/19/2021
Last Update Date	:	11/04/2022

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