Provider Demographics
NPI:1821357997
Name:PATRICIA KENNEY COUNSELING SERVICES, LLC
Entity Type:Organization
Organization Name:PATRICIA KENNEY COUNSELING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER
Authorized Official - Prefix:MS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:KENNEY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, MAC
Authorized Official - Phone:856-691-2424
Mailing Address - Street 1:717 E ELMER ST
Mailing Address - Street 2:SUITE 6
Mailing Address - City:VINELAND
Mailing Address - State:NJ
Mailing Address - Zip Code:08360-4758
Mailing Address - Country:US
Mailing Address - Phone:856-691-2424
Mailing Address - Fax:856-691-2433
Practice Address - Street 1:717 E ELMER ST
Practice Address - Street 2:SUITE 6
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08360-4758
Practice Address - Country:US
Practice Address - Phone:856-691-2424
Practice Address - Fax:856-691-2433
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-10
Last Update Date:2012-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC047646001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ272399000OtherMAGELLAN BEHAVIORAL HEALTH PIN
NJ046194Medicare PIN