Provider Demographics
NPI:1124361365
Name:KERR, STACEY D (LSW)
Entity Type:Individual
Prefix:MRS
First Name:STACEY
Middle Name:D
Last Name:KERR
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:MRS
Other - First Name:STACEY
Other - Middle Name:D
Other - Last Name:FRYE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LSW
Mailing Address - Street 1:3664 ROUTE 30
Mailing Address - Street 2:
Mailing Address - City:LATROBE
Mailing Address - State:PA
Mailing Address - Zip Code:15650-5208
Mailing Address - Country:US
Mailing Address - Phone:724-539-1588
Mailing Address - Fax:724-539-1588
Practice Address - Street 1:3664 ROUTE 30
Practice Address - Street 2:
Practice Address - City:LATROBE
Practice Address - State:PA
Practice Address - Zip Code:15650-5208
Practice Address - Country:US
Practice Address - Phone:724-539-1588
Practice Address - Fax:724-539-1588
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-05
Last Update Date:2013-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW129596104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker