Provider Demographics
NPI:1699213405
Name:URIBE, KENNI (LCSW)
Entity Type:Individual
Prefix:
First Name:KENNI
Middle Name:
Last Name:URIBE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17752 W CROCUS DR
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85388-7526
Mailing Address - Country:US
Mailing Address - Phone:307-760-3007
Mailing Address - Fax:
Practice Address - Street 1:17752 W CROCUS DR
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85388-7526
Practice Address - Country:US
Practice Address - Phone:307-760-3007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-01
Last Update Date:2021-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW-165121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical