Provider Demographics
NPI:1780011171
Name:KENEPP, TIMOTHY RUSSELL (LSW, CRS A/D)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:RUSSELL
Last Name:KENEPP
Suffix:
Gender:M
Credentials:LSW, CRS A/D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1665 GREENLAWN AVE
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44301-2743
Mailing Address - Country:US
Mailing Address - Phone:330-319-3076
Mailing Address - Fax:
Practice Address - Street 1:1700 E 13TH ST STE 114
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44114-3285
Practice Address - Country:US
Practice Address - Phone:216-539-9239
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-01
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.1101368104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker