Provider Demographics
NPI:1417936527
Name:KENNEDY, NICOLE CRISTTIN (LCSW C)
Entity Type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:CRISTTIN
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:LCSW C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 FALLSWAY
Mailing Address - Street 2:HEALTH CARE FOR THE HOMELESS
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21202-4800
Mailing Address - Country:US
Mailing Address - Phone:410-837-5533
Mailing Address - Fax:410-837-8020
Practice Address - Street 1:421 FALLSWAY
Practice Address - Street 2:HEALTH CARE FOR THE HOMELESS
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21202-4800
Practice Address - Country:US
Practice Address - Phone:410-837-5533
Practice Address - Fax:410-837-8020
Is Sole Proprietor?:No
Enumeration Date:2006-01-17
Last Update Date:2010-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD119391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical