Provider Demographics
NPI:1518294412
Name:KENNY-WOODWORTH, MAUREEN (LICSW)
Entity Type:Individual
Prefix:
First Name:MAUREEN
Middle Name:
Last Name:KENNY-WOODWORTH
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 FOSTER ST
Mailing Address - Street 2:
Mailing Address - City:WAKEFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01880-2936
Mailing Address - Country:US
Mailing Address - Phone:781-850-5535
Mailing Address - Fax:781-246-8353
Practice Address - Street 1:9 FOSTER ST
Practice Address - Street 2:
Practice Address - City:WAKEFIELD
Practice Address - State:MA
Practice Address - Zip Code:01880-2936
Practice Address - Country:US
Practice Address - Phone:781-850-5535
Practice Address - Fax:781-246-8353
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-12
Last Update Date:2010-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10305111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical