Provider Demographics
NPI:1659829018
Name:MCRAE, KERRY (MSW)
Entity Type:Individual
Prefix:
First Name:KERRY
Middle Name:
Last Name:MCRAE
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9
Mailing Address - Street 2:
Mailing Address - City:HALIFAX
Mailing Address - State:MA
Mailing Address - Zip Code:02338-0009
Mailing Address - Country:US
Mailing Address - Phone:913-298-2625
Mailing Address - Fax:913-298-2018
Practice Address - Street 1:314 ELM ST
Practice Address - Street 2:
Practice Address - City:HALIFAX
Practice Address - State:MA
Practice Address - Zip Code:02338-1214
Practice Address - Country:US
Practice Address - Phone:913-298-2625
Practice Address - Fax:913-298-2018
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-14
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO1041C0700X
MA1178981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical