Provider Demographics
NPI:1275627374
Name:KENNY, PATRICIA ANN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:ANN
Last Name:KENNY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:PATRICIA
Other - Middle Name:ANN
Other - Last Name:KENNY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:202 FOURTH STREET
Mailing Address - Street 2:
Mailing Address - City:OLD TOWN
Mailing Address - State:ME
Mailing Address - Zip Code:04468
Mailing Address - Country:US
Mailing Address - Phone:207-827-2165
Mailing Address - Fax:207-992-2051
Practice Address - Street 1:157 PARK ST
Practice Address - Street 2:SUITE 35
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-5093
Practice Address - Country:US
Practice Address - Phone:207-992-9453
Practice Address - Fax:207-992-2051
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2008-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC74011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical