Provider Demographics
NPI:1720516305
Name:KEROACK, JESSICA G (PHD)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:G
Last Name:KEROACK
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 N CEDAR CREST BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18104-4664
Mailing Address - Country:US
Mailing Address - Phone:484-896-9600
Mailing Address - Fax:
Practice Address - Street 1:121 N CEDAR CREST BLVD STE A
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18104-4664
Practice Address - Country:US
Practice Address - Phone:484-896-9600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-26
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS018293103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAPS018293OtherSTATE LICENSE