Provider Demographics
NPI:1629781190
Name:MAIORCA, KERRY
Entity Type:Individual
Prefix:
First Name:KERRY
Middle Name:
Last Name:MAIORCA
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 1:1463 NORTH ST
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80304-3511
Mailing Address - Country:US
Mailing Address - Phone:773-251-2733
Mailing Address - Fax:
Practice Address - Street 1:700 12TH ST STE 220
Practice Address - Street 2:
Practice Address - City:GOLDEN
Practice Address - State:CO
Practice Address - Zip Code:80401-1231
Practice Address - Country:US
Practice Address - Phone:303-850-2695
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-29
Last Update Date:2022-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health