Provider Demographics
NPI:1972059236
Name:KENNEDY, CAROLINE (MSW)
Entity Type:Individual
Prefix:
First Name:CAROLINE
Middle Name:
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2245 S STATE ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48104-6184
Mailing Address - Country:US
Mailing Address - Phone:734-769-0209
Mailing Address - Fax:734-769-0224
Practice Address - Street 1:2245 S. STATE ST.
Practice Address - Street 2:SUITE 200
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-6184
Practice Address - Country:US
Practice Address - Phone:734-769-0209
Practice Address - Fax:734-769-0224
Is Sole Proprietor?:No
Enumeration Date:2016-08-28
Last Update Date:2016-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010929391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical