Provider Demographics
NPI:1639304439
Name:KERR, CLIVE HENRY (LCSW)
Entity Type:Individual
Prefix:MR
First Name:CLIVE
Middle Name:HENRY
Last Name:KERR
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1329 BEACH CHANNEL DR
Mailing Address - Street 2:
Mailing Address - City:FAR ROCKAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11691-3211
Mailing Address - Country:US
Mailing Address - Phone:718-337-6850
Mailing Address - Fax:718-868-3782
Practice Address - Street 1:1329 BEACH CHANNEL DR
Practice Address - Street 2:
Practice Address - City:FAR ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11691-3211
Practice Address - Country:US
Practice Address - Phone:718-337-6850
Practice Address - Fax:718-868-3782
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-21
Last Update Date:2011-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0747631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical