Provider Demographics
NPI:1205866324
Name:KERWIN, MARYLOUISE E (PHD)
Entity type:Individual
Prefix:DR
First Name:MARYLOUISE
Middle Name:E
Last Name:KERWIN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:201 MULLICA HILL RD
Mailing Address - Street 2:ROBINSON HALL
Mailing Address - City:GLASSBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08028-1700
Mailing Address - Country:US
Mailing Address - Phone:856-256-5470
Mailing Address - Fax:856-256-4892
Practice Address - Street 1:201 MULLICA HILL RD
Practice Address - Street 2:ROBINSON HALL
Practice Address - City:GLASSBORO
Practice Address - State:NJ
Practice Address - Zip Code:08028-1700
Practice Address - Country:US
Practice Address - Phone:856-256-5470
Practice Address - Fax:856-256-4892
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2016-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00381100103K00000X, 103T00000X, 103TA0400X, 103TB0200X, 103TC2200X, 103TM1800X
PAPS006790L103T00000X, 103TA0400X, 103TB0200X, 103TC2200X, 103TM1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0480380Medicaid