Provider Demographics
NPI:1508109745
Name:BAXTER, KERRY (LCSW)
Entity Type:Individual
Prefix:MS
First Name:KERRY
Middle Name:
Last Name:BAXTER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 95000
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19195-4655
Mailing Address - Country:US
Mailing Address - Phone:800-444-6020
Mailing Address - Fax:845-255-1881
Practice Address - Street 1:1 FOXHALL AVE
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401-5107
Practice Address - Country:US
Practice Address - Phone:845-338-8444
Practice Address - Fax:845-338-2906
Is Sole Proprietor?:No
Enumeration Date:2013-04-05
Last Update Date:2016-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY087008104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker