Provider Demographics
NPI:1609632587
Name:ANDREK, KERRY ANN
Entity Type:Individual
Prefix:
First Name:KERRY
Middle Name:ANN
Last Name:ANDREK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KERRY
Other - Middle Name:ANN
Other - Last Name:ANDREK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:2850 RT 3
Mailing Address - Street 2:
Mailing Address - City:THORNTON
Mailing Address - State:NH
Mailing Address - Zip Code:03285
Mailing Address - Country:US
Mailing Address - Phone:603-254-5689
Mailing Address - Fax:
Practice Address - Street 1:2850 RT 3
Practice Address - Street 2:
Practice Address - City:THORNTON
Practice Address - State:NH
Practice Address - Zip Code:03285
Practice Address - Country:US
Practice Address - Phone:603-254-5628
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-27
Last Update Date:2024-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1273101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)