Provider Demographics
NPI:1336457035
Name:KERRIGAN, DAVID WILLIAM MCLEOD (MSW, PHD, LCSW)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:WILLIAM MCLEOD
Last Name:KERRIGAN
Suffix:
Gender:M
Credentials:MSW, PHD, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:950 COUNTY SQUARE DR
Mailing Address - Street 2:SUITE 107
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-5410
Mailing Address - Country:US
Mailing Address - Phone:805-794-3165
Mailing Address - Fax:
Practice Address - Street 1:950 COUNTY SQUARE DR
Practice Address - Street 2:SUITE 107
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-5410
Practice Address - Country:US
Practice Address - Phone:805-794-3165
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-16
Last Update Date:2015-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA605041041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
12227828OtherCAQH PROVIDER ID
CACB212979Medicare PIN