Provider Demographics
NPI:1255106647
Name:BUDAGHER, KERRIE L (MSW, ISW)
Entity type:Individual
Prefix:
First Name:KERRIE
Middle Name:L
Last Name:BUDAGHER
Suffix:
Gender:F
Credentials:MSW, ISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:903 SW 9TH CT
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33991-2493
Mailing Address - Country:US
Mailing Address - Phone:505-228-4959
Mailing Address - Fax:
Practice Address - Street 1:2180 W 1ST ST
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33901-3222
Practice Address - Country:US
Practice Address - Phone:505-228-4959
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-16
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL17687106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist