Provider Demographics
NPI:1447839576
Name:KERRIGAN, STEPHANIE (PHD)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:KERRIGAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 STATE ST APT 4
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-3965
Mailing Address - Country:US
Mailing Address - Phone:609-330-5995
Mailing Address - Fax:
Practice Address - Street 1:1010 STATE ST APT 4
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-3965
Practice Address - Country:US
Practice Address - Phone:609-330-5995
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-06
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT8.003914103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist