Provider Demographics
NPI:1427225143
Name:THOMAS, KERI (LICSW, LCSW)
Entity Type:Individual
Prefix:MS
First Name:KERI
Middle Name:
Last Name:THOMAS
Suffix:
Gender:F
Credentials:LICSW, LCSW
Other - Prefix:
Other - First Name:KERI
Other - Middle Name:ANN
Other - Last Name:FARRELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LICSW
Mailing Address - Street 1:204 HAMPTON DR
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:CA
Mailing Address - Zip Code:90291-2623
Mailing Address - Country:US
Mailing Address - Phone:310-293-3468
Mailing Address - Fax:310-392-8402
Practice Address - Street 1:39 BOYLSTON ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02116-4702
Practice Address - Country:US
Practice Address - Phone:617-654-1258
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-12
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW28761101YM0800X
DCLC500798291041C0700X
225400000X, 251V00000X
VA09040126171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
No251V00000XAgenciesVoluntary or Charitable