Provider Demographics
NPI:1497807465
Name:ALEXANDER, KERRY PUGH (LICSW)
Entity Type:Individual
Prefix:MS
First Name:KERRY
Middle Name:PUGH
Last Name:ALEXANDER
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:MS
Other - First Name:KERRY
Other - Middle Name:CAMPBELL
Other - Last Name:PUGH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LICSW
Mailing Address - Street 1:59 AYER RD
Mailing Address - Street 2:
Mailing Address - City:HARVARD
Mailing Address - State:MA
Mailing Address - Zip Code:01451-1214
Mailing Address - Country:US
Mailing Address - Phone:978-456-9734
Mailing Address - Fax:
Practice Address - Street 1:518 GREAT RD
Practice Address - Street 2:BOUNDARIES
Practice Address - City:ACTON
Practice Address - State:MA
Practice Address - Zip Code:01720-3415
Practice Address - Country:US
Practice Address - Phone:978-263-4878
Practice Address - Fax:978-635-0386
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA110966LICSW1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical