Provider Demographics
NPI:1386129922
Name:FAHEY, KERRI (LICSW)
Entity type:Individual
Prefix:
First Name:KERRI
Middle Name:
Last Name:FAHEY
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:161 PROSPECT ST
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:MA
Mailing Address - Zip Code:01867-2335
Mailing Address - Country:US
Mailing Address - Phone:617-610-7498
Mailing Address - Fax:
Practice Address - Street 1:171 PINE ST
Practice Address - Street 2:
Practice Address - City:AUBURNDALE
Practice Address - State:MA
Practice Address - Zip Code:02466-1361
Practice Address - Country:US
Practice Address - Phone:617-559-9360
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-29
Last Update Date:2018-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA110252-SW-LICSW1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical