Provider Demographics
NPI:1316520265
Name:MCLOUGHLIN, KERRY M
Entity type:Individual
Prefix:MRS
First Name:KERRY
Middle Name:M
Last Name:MCLOUGHLIN
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 1:2818 RONALD ST
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92506-4149
Mailing Address - Country:US
Mailing Address - Phone:803-447-6691
Mailing Address - Fax:
Practice Address - Street 1:658 E BRIER DR STE 200
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92408-2847
Practice Address - Country:US
Practice Address - Phone:909-501-0700
Practice Address - Fax:909-387-7611
Is Sole Proprietor?:No
Enumeration Date:2021-04-29
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CA108650101YM0800X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health