Provider Demographics
NPI:1861678435
Name:KENNEDY, MICHAEL GEORGE (LCSW)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:GEORGE
Last Name:KENNEDY
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1290 W 8TH PL
Mailing Address - Street 2:SUITE A
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-3621
Mailing Address - Country:US
Mailing Address - Phone:928-344-4310
Mailing Address - Fax:928-344-4366
Practice Address - Street 1:1290 W 8TH PL
Practice Address - Street 2:SUITE A
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-3621
Practice Address - Country:US
Practice Address - Phone:928-344-4310
Practice Address - Fax:928-344-4366
Is Sole Proprietor?:No
Enumeration Date:2008-01-14
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW-103211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical