Provider Demographics
NPI:1467990002
Name:BAHARANYI, KERRY (LICSW)
Entity Type:Individual
Prefix:
First Name:KERRY
Middle Name:
Last Name:BAHARANYI
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:409 E THACH AVE
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:AL
Mailing Address - Zip Code:36830-5539
Mailing Address - Country:US
Mailing Address - Phone:334-707-6007
Mailing Address - Fax:
Practice Address - Street 1:122 N 20TH ST
Practice Address - Street 2:BUILDING #26
Practice Address - City:OPELIKA
Practice Address - State:AL
Practice Address - Zip Code:36801-5442
Practice Address - Country:US
Practice Address - Phone:334-749-3593
Practice Address - Fax:334-749-3594
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-02
Last Update Date:2017-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3830C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical