Provider Demographics
NPI:1043711039
Name:SMITH, KERRY LYNN (LCSW)
Entity Type:Individual
Prefix:
First Name:KERRY
Middle Name:LYNN
Last Name:SMITH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:DEEP RIVER
Mailing Address - State:CT
Mailing Address - Zip Code:06417-2117
Mailing Address - Country:US
Mailing Address - Phone:860-391-3647
Mailing Address - Fax:
Practice Address - Street 1:37 RIVER RD
Practice Address - Street 2:
Practice Address - City:DEEP RIVER
Practice Address - State:CT
Practice Address - Zip Code:06417-2117
Practice Address - Country:US
Practice Address - Phone:860-391-3647
Practice Address - Fax:860-388-9656
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-24
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
CT0044281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical