Provider Demographics
NPI:1972956530
Name:MABERRY, KERMINDRA L (LCSW)
Entity type:Individual
Prefix:
First Name:KERMINDRA
Middle Name:L
Last Name:MABERRY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:KERMINDRA
Other - Middle Name:L
Other - Last Name:MABERRY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:61540 BENNETT RD
Mailing Address - Street 2:
Mailing Address - City:AMITE
Mailing Address - State:LA
Mailing Address - Zip Code:70422-4356
Mailing Address - Country:US
Mailing Address - Phone:985-474-4958
Mailing Address - Fax:
Practice Address - Street 1:61540 BENNETT RD
Practice Address - Street 2:
Practice Address - City:AMITE
Practice Address - State:LA
Practice Address - Zip Code:70422-4356
Practice Address - Country:US
Practice Address - Phone:985-474-4958
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-19
Last Update Date:2019-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA128661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical