Provider Demographics
NPI:1508085325
Name:KERNER, MICHELE SUSAN (ACSW, LCSW)
Entity Type:Individual
Prefix:MS
First Name:MICHELE
Middle Name:SUSAN
Last Name:KERNER
Suffix:
Gender:F
Credentials:ACSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2702 MILL AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-6422
Mailing Address - Country:US
Mailing Address - Phone:718-209-4396
Mailing Address - Fax:718-209-4397
Practice Address - Street 1:920 48TH ST
Practice Address - Street 2:MAIMONIDES DEPT. OF PSYCHIATRY
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11219-2918
Practice Address - Country:US
Practice Address - Phone:718-283-7681
Practice Address - Fax:718-283-6161
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR034765-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical