Provider Demographics
NPI:1871594523
Name:KERWIN, GRETA L (PSYD)
Entity type:Individual
Prefix:
First Name:GRETA
Middle Name:L
Last Name:KERWIN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8117 PRESTON RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75225-6332
Mailing Address - Country:US
Mailing Address - Phone:214-907-2433
Mailing Address - Fax:888-519-5344
Practice Address - Street 1:8117 PRESTON RD
Practice Address - Street 2:SUITE 300
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75225-6332
Practice Address - Country:US
Practice Address - Phone:214-907-2433
Practice Address - Fax:888-519-5344
Is Sole Proprietor?:No
Enumeration Date:2005-08-03
Last Update Date:2012-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX32241103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX153806802Medicaid
TX8D0717Medicare ID - Type Unspecified