Provider Demographics
NPI:1316828932
Name:KERR, CASEY (LEP)
Entity type:Individual
Prefix:
First Name:CASEY
Middle Name:
Last Name:KERR
Suffix:
Gender:M
Credentials:LEP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 COMPTON CIR APT C
Mailing Address - Street 2:
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94583-1688
Mailing Address - Country:US
Mailing Address - Phone:925-575-7084
Mailing Address - Fax:
Practice Address - Street 1:9870 BROADMOOR DR
Practice Address - Street 2:
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583-2942
Practice Address - Country:US
Practice Address - Phone:925-575-7084
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-10
Last Update Date:2025-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA230054283103TS0200X
CA4587103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool