Provider Demographics
NPI:1770704595
Name:KERN, LOIS S (BA MSW PHD)
Entity type:Individual
Prefix:DR
First Name:LOIS
Middle Name:S
Last Name:KERN
Suffix:
Gender:F
Credentials:BA MSW PHD
Other - Prefix:
Other - First Name:LOIS
Other - Middle Name:
Other - Last Name:SOUTH BROOKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BA MSW PHD
Mailing Address - Street 1:PO BOX 0891
Mailing Address - Street 2:KABBALAH NISSIONARY PHYS SW GROUP
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-0891
Mailing Address - Country:US
Mailing Address - Phone:718-720-0292
Mailing Address - Fax:718-761-5562
Practice Address - Street 1:800 MANOR ROAD
Practice Address - Street 2:PROFESSIONAL SUITES #2V KABBALAH MISSRY PHYS SW GROUP
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-7016
Practice Address - Country:US
Practice Address - Phone:347-613-7836
Practice Address - Fax:718-761-5562
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SW14464101YM0800X, 1041C0700X, 221700000X
NJSW144641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist