Provider Demographics
NPI:1083942445
Name:BERGERON, KERRY CARTER (LMHC)
Entity Type:Individual
Prefix:MRS
First Name:KERRY
Middle Name:CARTER
Last Name:BERGERON
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 MAPLE STREET
Mailing Address - Street 2:
Mailing Address - City:HOLDEN
Mailing Address - State:MA
Mailing Address - Zip Code:01520
Mailing Address - Country:US
Mailing Address - Phone:508-479-9151
Mailing Address - Fax:
Practice Address - Street 1:21 MAPLE STREET
Practice Address - Street 2:
Practice Address - City:HOLDEN
Practice Address - State:MA
Practice Address - Zip Code:01520
Practice Address - Country:US
Practice Address - Phone:508-479-9151
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-24
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8379101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health