Provider Demographics
NPI:1073038808
Name:KENOFF, ANDREA LAURYN (LICSW)
Entity Type:Individual
Prefix:MS
First Name:ANDREA
Middle Name:LAURYN
Last Name:KENOFF
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4601 CONNECTICUT AVE NW APT 511
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20008-5710
Mailing Address - Country:US
Mailing Address - Phone:200-498-8228
Mailing Address - Fax:202-824-2554
Practice Address - Street 1:4601 CONNECTICUT AVENUE NORTHWEST
Practice Address - Street 2:APARTMENT 511
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20008
Practice Address - Country:US
Practice Address - Phone:200-498-8228
Practice Address - Fax:202-824-2554
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
DCLC500813321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical