Provider Demographics
NPI:1699803833
Name:KERLE, FREDERICK J (LADC 1)
Entity type:Individual
Prefix:
First Name:FREDERICK
Middle Name:J
Last Name:KERLE
Suffix:
Gender:M
Credentials:LADC 1
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:199 SUMMER ST
Mailing Address - Street 2:
Mailing Address - City:DUXBURY
Mailing Address - State:MA
Mailing Address - Zip Code:02332-4256
Mailing Address - Country:US
Mailing Address - Phone:781-585-4845
Mailing Address - Fax:
Practice Address - Street 1:105 PARK ST
Practice Address - Street 2:
Practice Address - City:HYANNIS
Practice Address - State:MA
Practice Address - Zip Code:02601-5205
Practice Address - Country:US
Practice Address - Phone:508-771-9599
Practice Address - Fax:508-771-1986
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA226101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)