Provider Demographics
NPI:1255868121
Name:KENNEDY, KATHLEEN MARIE (LCSW)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:MARIE
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 1:3106 S W S YOUNG DR STE 201B
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76542-2008
Mailing Address - Country:US
Mailing Address - Phone:254-519-4162
Mailing Address - Fax:254-519-3464
Practice Address - Street 1:3106 S W S YOUNG DR STE 201B
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76542-2008
Practice Address - Country:US
Practice Address - Phone:254-519-4162
Practice Address - Fax:254-519-3464
Is Sole Proprietor?:No
Enumeration Date:2017-05-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI16000801041C0700X
TX623181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical