Provider Demographics
NPI:1447459698
Name:MCAVAY-REDNER, KERRI A (LCSW)
Entity type:Individual
Prefix:
First Name:KERRI
Middle Name:A
Last Name:MCAVAY-REDNER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:KERRI
Other - Middle Name:
Other - Last Name:MCAVAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:206 MCKINLEY AVENUE EXT
Mailing Address - Street 2:
Mailing Address - City:NORWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06360-3536
Mailing Address - Country:US
Mailing Address - Phone:860-934-5123
Mailing Address - Fax:
Practice Address - Street 1:8 MAHAN DR
Practice Address - Street 2:
Practice Address - City:NORWICH
Practice Address - State:CT
Practice Address - Zip Code:06360-2426
Practice Address - Country:US
Practice Address - Phone:860-934-5123
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-17
Last Update Date:2024-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0064911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT006491OtherCONNECTICUT LICENSED CLIN
CT004271425Medicaid