Provider Demographics
NPI:1235569294
Name:MCGILL, KERRY (LMFT)
Entity Type:Individual
Prefix:
First Name:KERRY
Middle Name:
Last Name:MCGILL
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:63 E CENTER ST STE 2R
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06040-5221
Mailing Address - Country:US
Mailing Address - Phone:860-281-1133
Mailing Address - Fax:
Practice Address - Street 1:63 E CENTER ST STE 2R
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06040-5221
Practice Address - Country:US
Practice Address - Phone:860-281-1133
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-12
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001255106H00000X
IL166.000852106H00000X
CT002846106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist