Provider Demographics
NPI:1447806005
Name:HAWTHORNE, KENRICK SINCLAIR JR (ADVANCED CASAC)
Entity Type:Individual
Prefix:MR
First Name:KENRICK
Middle Name:SINCLAIR
Last Name:HAWTHORNE
Suffix:JR
Gender:M
Credentials:ADVANCED CASAC
Other - Prefix:
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Mailing Address - Street 1:311 E 175TH ST
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10457-5848
Mailing Address - Country:US
Mailing Address - Phone:718-764-1551
Mailing Address - Fax:718-764-1583
Practice Address - Street 1:1064 FRANKLIN AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10456-6704
Practice Address - Country:US
Practice Address - Phone:718-764-1551
Practice Address - Fax:718-764-1583
Is Sole Proprietor?:No
Enumeration Date:2019-08-09
Last Update Date:2020-05-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY25248101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)