Provider Demographics
NPI:1295009124
Name:SLEZAK, KERRI L (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:KERRI
Middle Name:L
Last Name:SLEZAK
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 1:108 GROVE ST STE LL11
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01605-2677
Mailing Address - Country:US
Mailing Address - Phone:508-304-7499
Mailing Address - Fax:774-420-7255
Practice Address - Street 1:108 GROVE ST STE LL11
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01605-2677
Practice Address - Country:US
Practice Address - Phone:508-304-7499
Practice Address - Fax:774-420-7255
Is Sole Proprietor?:No
Enumeration Date:2012-02-23
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RICSW014591041C0700X
MA2284721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical