Provider Demographics
NPI:1922254945
Name:HACKETT, KENRICK WADSWORTH JR (LCSW)
Entity Type:Individual
Prefix:MR
First Name:KENRICK
Middle Name:WADSWORTH
Last Name:HACKETT
Suffix:JR
Gender:M
Credentials:LCSW
Other - Prefix:
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Mailing Address - Street 1:5971 DREXEL RD
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19131-1215
Mailing Address - Country:US
Mailing Address - Phone:215-877-8598
Mailing Address - Fax:
Practice Address - Street 1:1489 BALTIMORE PIKE STE 200
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:PA
Practice Address - Zip Code:19064-3958
Practice Address - Country:US
Practice Address - Phone:610-604-9510
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-10
Last Update Date:2008-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0159781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical