Provider Demographics
NPI:1386844421
Name:KEROUACK-WARNER, PAMELA A (LPC)
Entity Type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:A
Last Name:KEROUACK-WARNER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:312 N SOCIETY RD
Mailing Address - Street 2:
Mailing Address - City:CANTERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06331-1243
Mailing Address - Country:US
Mailing Address - Phone:860-465-7926
Mailing Address - Fax:
Practice Address - Street 1:312 N SOCIETY RD
Practice Address - Street 2:
Practice Address - City:CANTERBURY
Practice Address - State:CT
Practice Address - Zip Code:06331-1243
Practice Address - Country:US
Practice Address - Phone:860-465-7926
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-18
Last Update Date:2007-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000456101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional