Provider Demographics
NPI:1639727142
Name:KERIN, LISA CAROL (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:CAROL
Last Name:KERIN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06460-4725
Mailing Address - Country:US
Mailing Address - Phone:203-877-1099
Mailing Address - Fax:203-876-0100
Practice Address - Street 1:120 BROAD ST
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06460-4725
Practice Address - Country:US
Practice Address - Phone:203-877-1099
Practice Address - Fax:203-876-0100
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-28
Last Update Date:2019-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0050641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical