Provider Demographics
NPI:1184974420
Name:DAVIES, KERRY K (LCSW)
Entity type:Individual
Prefix:
First Name:KERRY
Middle Name:K
Last Name:DAVIES
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12337 HANCOCK ST
Mailing Address - Street 2:STE 20
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-5885
Mailing Address - Country:US
Mailing Address - Phone:317-706-6744
Mailing Address - Fax:317-706-6700
Practice Address - Street 1:12337 HANCOCK ST
Practice Address - Street 2:STE 20
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-5885
Practice Address - Country:US
Practice Address - Phone:317-706-6744
Practice Address - Fax:317-706-6700
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-13
Last Update Date:2015-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34006630A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201178980AMedicaid
IN201163980Medicaid
ININ1231OtherMEDICARE GROUP
IN201163980Medicaid