Provider Demographics
NPI:1922248194
Name:KERRIGAN, SANDRA (LGSW)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:KERRIGAN
Suffix:
Gender:F
Credentials:LGSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13326 DELAWARE RD
Mailing Address - Street 2:
Mailing Address - City:BISHOPVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21813-1188
Mailing Address - Country:US
Mailing Address - Phone:443-614-0099
Mailing Address - Fax:
Practice Address - Street 1:9730 HEALTHWAY DRIVE
Practice Address - Street 2:WORCESTER CO. HEALTH DEPT - BERLIN HEALTH CENTER
Practice Address - City:BERLIN
Practice Address - State:MD
Practice Address - Zip Code:21811
Practice Address - Country:US
Practice Address - Phone:410-629-0164
Practice Address - Fax:410-629-0185
Is Sole Proprietor?:No
Enumeration Date:2009-03-02
Last Update Date:2009-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD14278104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD705371101Medicaid
MDS013Medicare UPIN