Provider Demographics
NPI:1740878305
Name:BLODGETT, KERRY ANN (LICSW)
Entity type:Individual
Prefix:MRS
First Name:KERRY
Middle Name:ANN
Last Name:BLODGETT
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:85 TENNIS PLAZA RD UNIT 11
Mailing Address - Street 2:
Mailing Address - City:DRACUT
Mailing Address - State:MA
Mailing Address - Zip Code:01826-3390
Mailing Address - Country:US
Mailing Address - Phone:781-258-6428
Mailing Address - Fax:
Practice Address - Street 1:269 TREBLE COVE RD
Practice Address - Street 2:
Practice Address - City:NORTH BILLERICA
Practice Address - State:MA
Practice Address - Zip Code:01862-2830
Practice Address - Country:US
Practice Address - Phone:978-932-3365
Practice Address - Fax:978-932-3576
Is Sole Proprietor?:No
Enumeration Date:2021-01-08
Last Update Date:2021-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1190411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical