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Organization
DR KERRIE LLC
Active
Organization
DR KERRIE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KERRIE JONGENEELEN PSY.D. (CLINICAL PSYCHOLOGIST)
(617) 372-5653
Entity
Organization
Contact information
Practice address
10 HAWTHORNE PARK, CAMBRIDGE, MA 02138-2104
(617) 372-5653
Mailing address
405 CONCORD AVE UNIT 386, BELMONT, MA 02478-7818
(617) 372-5653
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
—
NULL
103TC0700X
Clinical Psychologist
—
—
103TC1900X
Counseling Psychologist
—
NULL
103TC1900X
Counseling Psychologist
—
—
103TC2200X
Clinical Child & Adolescent Psychologist
Primary
—
NULL
103TC2200X
Clinical Child & Adolescent Psychologist
Primary
—
—
103TF0000X
Family Psychologist
—
NULL
103TF0000X
Family Psychologist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110138961
—
MA
Enumeration date
04/07/2019
Last updated
06/11/2019
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