Active NPI
Stacie Leigh Kervin, LPC, NCC
- Professional Counselor
- Cheshire, CT
National Provider Identifier
1316101348
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 001705
- Practice address
- 116 S Brooksvale Rd
Cheshire, CT 06410-3512 - Phone
- (757) 621-8865
- NPI assigned
- Jul 18, 2008
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 001705 | CT | Primary |
Addresses
Primary practice location
116 S Brooksvale Rd
Cheshire, CT 06410-3512
Mailing address
116 S Brooksvale Rd
Cheshire, CT 06410-3512
Phone (757) 621-8865
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 001705 | CT | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1216339200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1216339200000",
"number": "1316101348",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "116 S BROOKSVALE RD",
"city": "CHESHIRE",
"state": "CT",
"postal_code": "064103512",
"telephone_number": "757-621-8865"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "116 S BROOKSVALE RD",
"city": "CHESHIRE",
"state": "CT",
"postal_code": "064103512",
"telephone_number": "757-621-8865"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KERVIN",
"first_name": "STACIE",
"middle_name": "LEIGH",
"credential": "LPC, NCC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-07-18",
"last_updated": "2008-07-18",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "CT",
"license": "001705",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Cheshire, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.