Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103K00000X | Behavior Analyst | 35SI00381100 | NJ |
Y | 102L00000X | Psychologist | 35SI00381100 | NJ |
Y | 103T00000X | Psychologist | 35SI00381100 | NJ |
N | 102L00000X | Psychologist | PS006790L | PA |
N | 103T00000X | Psychologist | PS006790L | PA |
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | 35SI00381100 | NJ |
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | PS006790L | PA |
N | 103TB0200X | Cognitive & Behavioral Psychologist | 35SI00381100 | NJ |
N | 103TB0200X | Cognitive & Behavioral Psychologist | PS006790L | PA |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | 35SI00381100 | NJ |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | PS006790L | PA |
N | 103TM1800X | Intellectual & Developmental Disabilities | 35SI00381100 | NJ |
N | 103TM1800X | Intellectual & Developmental Disabilities | PS006790L | PA |
NPI | 1205866324 |
---|---|
Provider Name | Dr. Marylouise E Kerwin |
First Address | Glassboro, NJ 08028-1700 |
Second Address | Glassboro, NJ 08028-1700 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/07/2006 |
Last Update Date | 05/01/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0480380 | (05) | NJ |