Provider Demographics
NPI:1235559089
Name:KENNEY, SUSAN DAWN
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:DAWN
Last Name:KENNEY
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:SUSAN
Other - Middle Name:DAWN
Other - Last Name:LOWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:489 BERNARDSTON RD
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01301-1238
Mailing Address - Country:US
Mailing Address - Phone:413-313-5347
Mailing Address - Fax:
Practice Address - Street 1:489 BERNARDSTON RD
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:MA
Practice Address - Zip Code:01301-1238
Practice Address - Country:US
Practice Address - Phone:413-313-5347
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-20
Last Update Date:2014-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker