Provider Demographics
NPI:1891576690
Name:ELIZABETH KENNEDY A LICENSED CLINICAL SOCIAL WORKER, A PROFESSIONAL CO
Entity Type:Organization
Organization Name:ELIZABETH KENNEDY A LICENSED CLINICAL SOCIAL WORKER, A PROFESSIONAL CO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:VIRGILIA
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:KENNEDY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:805-878-1863
Mailing Address - Street 1:PO BOX 7842
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93456-7842
Mailing Address - Country:US
Mailing Address - Phone:805-878-1863
Mailing Address - Fax:805-944-1543
Practice Address - Street 1:1505 SHEPARD DR STE 204
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-7016
Practice Address - Country:US
Practice Address - Phone:805-765-2300
Practice Address - Fax:805-944-1543
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-09
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)