Provider Demographics
NPI:1750317459
Name:KERSHAW, S REBECCA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:S
Middle Name:REBECCA
Last Name:KERSHAW
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 1:1457 GEORGIA PL
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39507-1434
Mailing Address - Country:US
Mailing Address - Phone:228-376-3648
Mailing Address - Fax:228-377-6427
Practice Address - Street 1:301 FISHER ST
Practice Address - Street 2:KEESLER MEDICAL CENTER
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39534-2508
Practice Address - Country:US
Practice Address - Phone:228-376-3648
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS003541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical