Provider Demographics
NPI:1053540682
Name:KERR, JILL ANNE RAYMOND (LCSW, LISAC)
Entity type:Individual
Prefix:MS
First Name:JILL
Middle Name:ANNE RAYMOND
Last Name:KERR
Suffix:
Gender:F
Credentials:LCSW, LISAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1609 N 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85705-6707
Mailing Address - Country:US
Mailing Address - Phone:520-901-0076
Mailing Address - Fax:
Practice Address - Street 1:1609 N 5TH AVE
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85705-6707
Practice Address - Country:US
Practice Address - Phone:520-901-0076
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-02
Last Update Date:2009-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLISAC-0885101YA0400X
AZLCSW-127401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)