Provider Demographics
NPI:1720438856
Name:CARGILL, KERYTH EVALYN (LICSW)
Entity Type:Individual
Prefix:
First Name:KERYTH
Middle Name:EVALYN
Last Name:CARGILL
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:62 WARE ST
Mailing Address - Street 2:P. O. BOX 1125
Mailing Address - City:WEST BROOKFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01585-3136
Mailing Address - Country:US
Mailing Address - Phone:508-867-4491
Mailing Address - Fax:508-867-3555
Practice Address - Street 1:62 WARE ST
Practice Address - Street 2:
Practice Address - City:WEST BROOKFIELD
Practice Address - State:MA
Practice Address - Zip Code:01585-3136
Practice Address - Country:US
Practice Address - Phone:508-867-4491
Practice Address - Fax:508-867-3555
Is Sole Proprietor?:No
Enumeration Date:2016-06-20
Last Update Date:2016-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1163991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical