Provider Demographics
NPI:1568695138
Name:KENNEY, CARLA ANN (LMHC)
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:ANN
Last Name:KENNEY
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1130
Mailing Address - Street 2:
Mailing Address - City:BERLIN
Mailing Address - State:MA
Mailing Address - Zip Code:01503-2130
Mailing Address - Country:US
Mailing Address - Phone:781-775-1127
Mailing Address - Fax:
Practice Address - Street 1:57 BARTON RD
Practice Address - Street 2:
Practice Address - City:STOW
Practice Address - State:MA
Practice Address - Zip Code:01775-1530
Practice Address - Country:US
Practice Address - Phone:781-775-1127
Practice Address - Fax:978-567-8703
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-31
Last Update Date:2009-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6503174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist