Provider Demographics
NPI:1013597087
Name:DEWOLF, KERRI ANNE
Entity Type:Individual
Prefix:MRS
First Name:KERRI
Middle Name:ANNE
Last Name:DEWOLF
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KERRI
Other - Middle Name:ANNE
Other - Last Name:WAYSTACK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:27 MALVERN ST
Mailing Address - Street 2:
Mailing Address - City:MELROSE
Mailing Address - State:MA
Mailing Address - Zip Code:02176-4741
Mailing Address - Country:US
Mailing Address - Phone:617-529-8181
Mailing Address - Fax:
Practice Address - Street 1:170 GOVERNORS AVE
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02155-1643
Practice Address - Country:US
Practice Address - Phone:781-306-6157
Practice Address - Fax:781-306-6146
Is Sole Proprietor?:No
Enumeration Date:2021-04-13
Last Update Date:2021-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical