Provider Demographics
NPI:1174234231
Name:GUERRA, KERRYE DEEANN (LMSW-C)
Entity type:Individual
Prefix:
First Name:KERRYE
Middle Name:DEEANN
Last Name:GUERRA
Suffix:
Gender:F
Credentials:LMSW-C
Other - Prefix:
Other - First Name:KERRYE
Other - Middle Name:DEEANN
Other - Last Name:PETRIK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW-C
Mailing Address - Street 1:1000 HOUGHTON AVE
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48602-5303
Mailing Address - Country:US
Mailing Address - Phone:989-558-6425
Mailing Address - Fax:989-746-7500
Practice Address - Street 1:28475 GREENFIELD RD STE 113
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48076-3034
Practice Address - Country:US
Practice Address - Phone:248-962-3329
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-09
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011153001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical