Provider Demographics
NPI:1881683209
Name:MCCONAGHY, KERI (LICSW)
Entity Type:Individual
Prefix:
First Name:KERI
Middle Name:
Last Name:MCCONAGHY
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 1:32 MERMAID AVE
Mailing Address - Street 2:
Mailing Address - City:WINTHROP
Mailing Address - State:MA
Mailing Address - Zip Code:02152-1123
Mailing Address - Country:US
Mailing Address - Phone:617-335-8877
Mailing Address - Fax:
Practice Address - Street 1:235 OCALLAGHAN WAY
Practice Address - Street 2:
Practice Address - City:LYNN
Practice Address - State:MA
Practice Address - Zip Code:01905
Practice Address - Country:US
Practice Address - Phone:781-691-7157
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-18
Last Update Date:2018-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1112441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical