Provider Demographics
NPI:1720536451
Name:PETRONE, PSYD, KERI BOYLAN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:KERI
Middle Name:BOYLAN
Last Name:PETRONE, PSYD
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:482 SPRINGFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:SUMMIT
Mailing Address - State:NJ
Mailing Address - Zip Code:07901-2601
Mailing Address - Country:US
Mailing Address - Phone:908-273-5558
Mailing Address - Fax:
Practice Address - Street 1:482 SPRINGFIELD AVE
Practice Address - Street 2:
Practice Address - City:SUMMIT
Practice Address - State:NJ
Practice Address - Zip Code:07901-2601
Practice Address - Country:US
Practice Address - Phone:908-273-5558
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-11
Last Update Date:2016-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ5634103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical