Provider Demographics
NPI:1225397425
Name:SHOTZ, KERRY (LMHC)
Entity Type:Individual
Prefix:MRS
First Name:KERRY
Middle Name:
Last Name:SHOTZ
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:MISS
Other - First Name:KERRY
Other - Middle Name:
Other - Last Name:MASON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:34 COURT ST
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02360-8721
Mailing Address - Country:US
Mailing Address - Phone:508-927-8388
Mailing Address - Fax:508-927-8401
Practice Address - Street 1:34 COURT ST
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02360-8721
Practice Address - Country:US
Practice Address - Phone:508-927-8388
Practice Address - Fax:508-927-8401
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-08
Last Update Date:2014-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4064101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health