Provider Demographics
NPI:1366739922
Name:LACERTE, KENNETH ROLAND (LMHC)
Entity type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:ROLAND
Last Name:LACERTE
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:416 HILLDALE AVE
Mailing Address - Street 2:
Mailing Address - City:HAVERHILL
Mailing Address - State:MA
Mailing Address - Zip Code:01832
Mailing Address - Country:US
Mailing Address - Phone:978-273-4128
Mailing Address - Fax:
Practice Address - Street 1:416 HILLDALE AVE
Practice Address - Street 2:
Practice Address - City:HAVERHILL
Practice Address - State:MA
Practice Address - Zip Code:01832-2561
Practice Address - Country:US
Practice Address - Phone:978-273-4128
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-05
Last Update Date:2017-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA530101YP2500X
MA521106H00000X
MA2072691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical