Provider Demographics
NPI:1245608751
Name:KENNEDY, DONNA LYNN (LCSW)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:LYNN
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 ELM ST STE 2
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07090-2179
Mailing Address - Country:US
Mailing Address - Phone:908-400-8843
Mailing Address - Fax:
Practice Address - Street 1:37 ELM ST STE 2
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07090-2179
Practice Address - Country:US
Practice Address - Phone:908-400-8843
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-14
Last Update Date:2015-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC055785001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical