Provider Demographics
NPI:1457594137
Name:KERRIGAN, DIANE ELAINE (MS, LPC)
Entity Type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:ELAINE
Last Name:KERRIGAN
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 SYCAMORE ST
Mailing Address - Street 2:
Mailing Address - City:TRAFFORD
Mailing Address - State:PA
Mailing Address - Zip Code:15085-1825
Mailing Address - Country:US
Mailing Address - Phone:412-856-4681
Mailing Address - Fax:
Practice Address - Street 1:131 MATHEWS ST
Practice Address - Street 2:SUITE 1501
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601-6939
Practice Address - Country:US
Practice Address - Phone:412-973-4617
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-10
Last Update Date:2014-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC004926101YP2500X, 101YM0800X
101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA728509Medicaid