Provider Demographics
NPI:1952670275
Name:KERRS, KENNETH JOSEPH II (LCSWR)
Entity Type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:JOSEPH
Last Name:KERRS
Suffix:II
Gender:M
Credentials:LCSWR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 EDUCATION DR
Mailing Address - Street 2:
Mailing Address - City:BEACON
Mailing Address - State:NY
Mailing Address - Zip Code:12508-4066
Mailing Address - Country:US
Mailing Address - Phone:845-838-6900
Mailing Address - Fax:
Practice Address - Street 1:23 ROWELL LN
Practice Address - Street 2:
Practice Address - City:WAPPINGERS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12590-4728
Practice Address - Country:US
Practice Address - Phone:845-298-2994
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-15
Last Update Date:2011-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR052069-1103K00000X
1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1302000100Medicaid