Basic Information
| Provider Information | |||||||||
| NPI: | 1699803833 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KERLE | ||||||||
| FirstName: | FREDERICK | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | LADC 1 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 199 SUMMER ST | ||||||||
| Address2: | |||||||||
| City: | DUXBURY | ||||||||
| State: | MA | ||||||||
| PostalCode: | 023324256 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7815854845 | ||||||||
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| Practice Location | |||||||||
| Address1: | 105 PARK ST | ||||||||
| Address2: | |||||||||
| City: | HYANNIS | ||||||||
| State: | MA | ||||||||
| PostalCode: | 026015205 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5087719599 | ||||||||
| FaxNumber: | 5087711986 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/01/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | 226 | MA | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.