Provider Demographics
NPI:1700361599
Name:KERRIGAN, NANCY AXON (LICSW)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:AXON
Last Name:KERRIGAN
Suffix:
Gender:F
Credentials:LICSW
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 997
Mailing Address - Street 2:
Mailing Address - City:EAST FALMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02536-0997
Mailing Address - Country:US
Mailing Address - Phone:508-548-5382
Mailing Address - Fax:
Practice Address - Street 1:12 QUASHNET WAY
Practice Address - Street 2:
Practice Address - City:EAST FALMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02536-7735
Practice Address - Country:US
Practice Address - Phone:508-548-5382
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-27
Last Update Date:2018-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA111484-SW-LICSW1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical