Individual
KERRI GEOGHEGAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
155 INDIAN HEAD RD, COMMACK, NY 11725-2212
(631) 543-6200
Mailing address
812 S BROADWAY, LINDENHURST, NY 11757-5606
(631) 747-8976
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
30983
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
30983
CERTIFICATE #
NY
Enumeration date
03/23/2016
Last updated
03/23/2016
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