Provider Demographics
NPI:1972176063
Name:HERLAN, KERI (PHD)
Entity type:Individual
Prefix:DR
First Name:KERI
Middle Name:
Last Name:HERLAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 WOODLAND DR
Mailing Address - Street 2:
Mailing Address - City:CHESHIRE
Mailing Address - State:CT
Mailing Address - Zip Code:06410-1675
Mailing Address - Country:US
Mailing Address - Phone:585-507-5351
Mailing Address - Fax:
Practice Address - Street 1:282 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06106-3322
Practice Address - Country:US
Practice Address - Phone:860-837-9700
Practice Address - Fax:860-837-9701
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-19
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY11143103TC0700X
CT8.004412103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPY11143OtherFL BOARD OF PSYCHOLOGY