Provider Demographics
NPI:1245785344
Name:KENNEDY, KAITLIN VALERI (LGSW)
Entity Type:Individual
Prefix:
First Name:KAITLIN
Middle Name:VALERI
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:LGSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:144 E SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21701-5636
Mailing Address - Country:US
Mailing Address - Phone:301-613-8270
Mailing Address - Fax:
Practice Address - Street 1:144 E SOUTH ST
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21701-5636
Practice Address - Country:US
Practice Address - Phone:301-613-8270
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-18
Last Update Date:2016-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD19252104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker