Provider Demographics
NPI:1184820789
Name:HENNESSY, KERRY SHEILA (LICSW)
Entity Type:Individual
Prefix:MS
First Name:KERRY
Middle Name:SHEILA
Last Name:HENNESSY
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 1:121B GREW AVE
Mailing Address - Street 2:
Mailing Address - City:ROSLINDALE
Mailing Address - State:MA
Mailing Address - Zip Code:02131-4678
Mailing Address - Country:US
Mailing Address - Phone:617-645-8175
Mailing Address - Fax:617-630-1570
Practice Address - Street 1:581 BOYLSTON ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02116-3608
Practice Address - Country:US
Practice Address - Phone:617-645-8175
Practice Address - Fax:617-630-1570
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1101551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical