Provider Demographics
NPI:1508340415
Name:KERSHAW, JUNE MARIE
Entity Type:Individual
Prefix:
First Name:JUNE
Middle Name:MARIE
Last Name:KERSHAW
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 CAUSEWAY ST
Mailing Address - Street 2:
Mailing Address - City:GLOUCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01930-2133
Mailing Address - Country:US
Mailing Address - Phone:781-608-6017
Mailing Address - Fax:
Practice Address - Street 1:50 CAUSEWAY ST
Practice Address - Street 2:
Practice Address - City:GLOUCESTER
Practice Address - State:MA
Practice Address - Zip Code:01930-2133
Practice Address - Country:US
Practice Address - Phone:781-608-6017
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-18
Last Update Date:2018-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10314661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical