Provider Demographics
NPI:1831311513
Name:KENNEDY, MARY ANN (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:MARY ANN
Middle Name:
Last Name:KENNEDY
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 1:2131 HIGHWAY RT 33
Mailing Address - Street 2:LEXINGTON SQUARE COMMONS
Mailing Address - City:HAMILTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08690
Mailing Address - Country:US
Mailing Address - Phone:609-585-4900
Mailing Address - Fax:609-585-4902
Practice Address - Street 1:2131 HIGHWAY RT 33
Practice Address - Street 2:LEXINGTON SQUARE COMMONS
Practice Address - City:HAMILTON
Practice Address - State:NJ
Practice Address - Zip Code:08690
Practice Address - Country:US
Practice Address - Phone:609-585-4900
Practice Address - Fax:609-585-4902
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC046414001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ087493RYDMedicare ID - Type Unspecified