Provider Demographics
NPI:1821248352
Name:GAVIN, KERRI LYNN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:KERRI
Middle Name:LYNN
Last Name:GAVIN
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 1:3022 SHASTA WAY
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95403-2664
Mailing Address - Country:US
Mailing Address - Phone:707-696-1632
Mailing Address - Fax:
Practice Address - Street 1:3022 SHASTA WAY
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95403-2664
Practice Address - Country:US
Practice Address - Phone:707-696-1632
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-20
Last Update Date:2019-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA237041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty