Provider Demographics
NPI:1033581913
Name:KENNEDY, SEAN (LCSW)
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:
Last Name:KENNEDY
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:484 OAK ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94102-5610
Mailing Address - Country:US
Mailing Address - Phone:415-626-5199
Mailing Address - Fax:415-626-2645
Practice Address - Street 1:484 OAK ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94102-5610
Practice Address - Country:US
Practice Address - Phone:156-265-1994
Practice Address - Fax:415-626-2645
Is Sole Proprietor?:No
Enumeration Date:2015-10-30
Last Update Date:2021-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31911101Y00000X
CA96029104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101Y00000XBehavioral Health & Social Service ProvidersCounselor