Provider Demographics
NPI:1497339659
Name:HARVAN, KERRIN (MA/SSP)
Entity Type:Individual
Prefix:
First Name:KERRIN
Middle Name:
Last Name:HARVAN
Suffix:
Gender:F
Credentials:MA/SSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 FINCH CT
Mailing Address - Street 2:
Mailing Address - City:COMMACK
Mailing Address - State:NY
Mailing Address - Zip Code:11725-4901
Mailing Address - Country:US
Mailing Address - Phone:631-521-0560
Mailing Address - Fax:
Practice Address - Street 1:9 FINCH CT
Practice Address - Street 2:
Practice Address - City:COMMACK
Practice Address - State:NY
Practice Address - Zip Code:11725-4901
Practice Address - Country:US
Practice Address - Phone:631-521-0560
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-12
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool