Provider Demographics
NPI:1972512416
Name:MCGRAW, KERRY CHRISTINE (CCC-A)
Entity Type:Individual
Prefix:
First Name:KERRY
Middle Name:CHRISTINE
Last Name:MCGRAW
Suffix:
Gender:F
Credentials:CCC-A
Other - Prefix:
Other - First Name:KERRY
Other - Middle Name:CHRISTINE
Other - Last Name:MORGANTI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CCC-A
Mailing Address - Street 1:888 WORCESTER ST
Mailing Address - Street 2:SUITE 130
Mailing Address - City:WELLESLEY
Mailing Address - State:MA
Mailing Address - Zip Code:02482-3744
Mailing Address - Country:US
Mailing Address - Phone:617-964-6681
Mailing Address - Fax:339-686-2561
Practice Address - Street 1:438 MAIN ST
Practice Address - Street 2:SUITE 204
Practice Address - City:MIDDLETOWN
Practice Address - State:CT
Practice Address - Zip Code:06457-3396
Practice Address - Country:US
Practice Address - Phone:888-964-6681
Practice Address - Fax:888-662-0859
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2016-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000325231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT730000325CT05OtherBLUE CROSS BLUE SHIELD
CT004214178Medicaid
CT640004193OtherMEDICARE RAILROAD
CTD400053212Medicare PIN