Provider Demographics
NPI:1841390234
Name:KERNAN, REGINA MARIE (LICSW)
Entity Type:Individual
Prefix:MRS
First Name:REGINA
Middle Name:MARIE
Last Name:KERNAN
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 1:39 PILLON ROAD
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:MA
Mailing Address - Zip Code:02186-4238
Mailing Address - Country:US
Mailing Address - Phone:617-698-2755
Mailing Address - Fax:
Practice Address - Street 1:SOUTH SHORE MENTAL HEALTH CENTER
Practice Address - Street 2:500 VICTORY ROAD
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02171-4238
Practice Address - Country:US
Practice Address - Phone:617-847-1950
Practice Address - Fax:617-774-1490
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2008-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA105785104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker