Provider Demographics
NPI:1306558002
Name:NEARY-WOOD, KERI
Entity type:Individual
Prefix:
First Name:KERI
Middle Name:
Last Name:NEARY-WOOD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 915
Mailing Address - Street 2:
Mailing Address - City:NORTH CHATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12132-0915
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:790 LANCASTER ST
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12203-1541
Practice Address - Country:US
Practice Address - Phone:518-489-4431
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-14
Last Update Date:2022-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY21590731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical