Provider Demographics
NPI:1841494622
Name:FERNALD, KERI R (LCMHC)
Entity type:Individual
Prefix:
First Name:KERI
Middle Name:R
Last Name:FERNALD
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:154 EMERYS BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH BERWICK
Mailing Address - State:ME
Mailing Address - Zip Code:03908-1904
Mailing Address - Country:US
Mailing Address - Phone:802-661-8259
Mailing Address - Fax:
Practice Address - Street 1:154 EMERYS BRIDGE RD
Practice Address - Street 2:
Practice Address - City:SOUTH BERWICK
Practice Address - State:ME
Practice Address - Zip Code:03908-1904
Practice Address - Country:US
Practice Address - Phone:802-661-8259
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-13
Last Update Date:2013-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1013101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health