Provider Demographics
NPI:1548789720
Name:KERL, DORETTA
Entity Type:Individual
Prefix:
First Name:DORETTA
Middle Name:
Last Name:KERL
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 1:3215 NEVIN AVE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:CA
Mailing Address - Zip Code:94804-1721
Mailing Address - Country:US
Mailing Address - Phone:510-232-7633
Mailing Address - Fax:510-215-2432
Practice Address - Street 1:3215 NEVIN AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:CA
Practice Address - Zip Code:94804-1721
Practice Address - Country:US
Practice Address - Phone:510-232-7633
Practice Address - Fax:510-215-2432
Is Sole Proprietor?:No
Enumeration Date:2017-09-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health