Provider Demographics
NPI:1932406923
Name:HANNAN, KERRY (PHD)
Entity Type:Individual
Prefix:DR
First Name:KERRY
Middle Name:
Last Name:HANNAN
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 1:2300 N CHARLES ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21218-5137
Mailing Address - Country:US
Mailing Address - Phone:410-396-6147
Mailing Address - Fax:410-235-1827
Practice Address - Street 1:2300 N CHARLES ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21218-5137
Practice Address - Country:US
Practice Address - Phone:410-396-6147
Practice Address - Fax:410-235-1827
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-28
Last Update Date:2011-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD2780103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD400924000Medicaid