Provider Demographics
NPI:1396925624
Name:KERR, CAROL LEET (D MIN, LCPC)
Entity type:Individual
Prefix:DR
First Name:CAROL
Middle Name:LEET
Last Name:KERR
Suffix:
Gender:F
Credentials:D MIN, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04101-3964
Mailing Address - Country:US
Mailing Address - Phone:207-761-2005
Mailing Address - Fax:207-761-2005
Practice Address - Street 1:38 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04101-3964
Practice Address - Country:US
Practice Address - Phone:207-761-2005
Practice Address - Fax:207-761-2005
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-03
Last Update Date:2007-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECC23101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME26946OtherANTHEM BLUE CROSS