Provider Demographics
NPI:1033548607
Name:MCKEON, KERRY
Entity Type:Individual
Prefix:
First Name:KERRY
Middle Name:
Last Name:MCKEON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 SPRUCE ST
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MA
Mailing Address - Zip Code:01510-2740
Mailing Address - Country:US
Mailing Address - Phone:203-313-0502
Mailing Address - Fax:
Practice Address - Street 1:1 CLARKS HL STE 302
Practice Address - Street 2:
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01702-8172
Practice Address - Country:US
Practice Address - Phone:508-589-5333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-05
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10000002101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health