Provider Demographics
NPI:1598281354
Name:ANDERSON, KERI MARIE (LICSW)
Entity Type:Individual
Prefix:MS
First Name:KERI
Middle Name:MARIE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:577 WESTERN AVE.
Mailing Address - Street 2:BOX 253
Mailing Address - City:WESTFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01086
Mailing Address - Country:US
Mailing Address - Phone:309-370-0632
Mailing Address - Fax:
Practice Address - Street 1:77 MILL ST STE 139
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:MA
Practice Address - Zip Code:01085-4598
Practice Address - Country:US
Practice Address - Phone:413-568-1421
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-14
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1226451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical