Provider Demographics
NPI:1508647546
Name:LABONTE, KERA LEE (LSW)
Entity Type:Individual
Prefix:
First Name:KERA
Middle Name:LEE
Last Name:LABONTE
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 DISTILLERY HILL RD
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:PA
Mailing Address - Zip Code:17814-8165
Mailing Address - Country:US
Mailing Address - Phone:570-854-5514
Mailing Address - Fax:
Practice Address - Street 1:816 CENTRAL RD
Practice Address - Street 2:
Practice Address - City:BLOOMSBURG
Practice Address - State:PA
Practice Address - Zip Code:17815-8976
Practice Address - Country:US
Practice Address - Phone:570-387-1832
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-06
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW128880104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker