Provider Demographics
NPI:1568531515
Name:WASHBURN, KERRY ANN (LMHC CADAC)
Entity Type:Individual
Prefix:
First Name:KERRY
Middle Name:ANN
Last Name:WASHBURN
Suffix:
Gender:F
Credentials:LMHC CADAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 FOSTER RD
Mailing Address - Street 2:NONE
Mailing Address - City:SWAMPSCOTT
Mailing Address - State:MA
Mailing Address - Zip Code:01907-1062
Mailing Address - Country:US
Mailing Address - Phone:781-599-1187
Mailing Address - Fax:
Practice Address - Street 1:30 BOSTON STREET
Practice Address - Street 2:CHILDREN'S FRIEND
Practice Address - City:LYNN,
Practice Address - State:MA
Practice Address - Zip Code:01904
Practice Address - Country:US
Practice Address - Phone:781-592-5691
Practice Address - Fax:781-595-4393
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5365101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health