Provider Demographics
NPI:1568834752
Name:CONNELL, KERRI (MSEDBCBA)
Entity Type:Individual
Prefix:
First Name:KERRI
Middle Name:
Last Name:CONNELL
Suffix:
Gender:F
Credentials:MSEDBCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56 ALLAN ST
Mailing Address - Street 2:
Mailing Address - City:MARSHFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:02050-5102
Mailing Address - Country:US
Mailing Address - Phone:508-965-5778
Mailing Address - Fax:
Practice Address - Street 1:56 ALLAN ST
Practice Address - Street 2:
Practice Address - City:MARSHFIELD
Practice Address - State:MA
Practice Address - Zip Code:02050-5102
Practice Address - Country:US
Practice Address - Phone:508-965-5778
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-27
Last Update Date:2015-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1-04-1932103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst