Provider Demographics
NPI:1689890659
Name:KENNY, LINDA M (LICSW)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:M
Last Name:KENNY
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 1:36 VILLAGE RD APT 512
Mailing Address - Street 2:
Mailing Address - City:MIDDLETON
Mailing Address - State:MA
Mailing Address - Zip Code:01949-1221
Mailing Address - Country:US
Mailing Address - Phone:978-836-0967
Mailing Address - Fax:
Practice Address - Street 1:435 NEWBURY ST STE 220
Practice Address - Street 2:
Practice Address - City:DANVERS
Practice Address - State:MA
Practice Address - Zip Code:01923-1065
Practice Address - Country:US
Practice Address - Phone:978-836-0967
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1102251041C0700X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110859OtherVALUE OPTIONS
MAP23350Medicare ID - Type UnspecifiedPROVIDER NUMBER