Provider Demographics
NPI:1164176392
Name:JODY KENYON, LCSW-R COUNSELING SERVICES
Entity Type:Organization
Organization Name:JODY KENYON, LCSW-R COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JODY
Authorized Official - Middle Name:M
Authorized Official - Last Name:KENYON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-R
Authorized Official - Phone:607-378-9791
Mailing Address - Street 1:3019 COUNTY HIGHWAY 11 SUITE 3
Mailing Address - Street 2:
Mailing Address - City:HARTWICK
Mailing Address - State:NY
Mailing Address - Zip Code:13348
Mailing Address - Country:US
Mailing Address - Phone:160-737-8979
Mailing Address - Fax:
Practice Address - Street 1:3019 COUNTY HIGHWAY 11 SUITE 3
Practice Address - Street 2:
Practice Address - City:HARTWICK
Practice Address - State:NY
Practice Address - Zip Code:13348
Practice Address - Country:US
Practice Address - Phone:160-737-8979
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-07
Last Update Date:2022-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty