Provider Demographics
NPI:1245475318
Name:KENNELLY, REBECCA J (MSW)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:J
Last Name:KENNELLY
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 1:285 BIELBY RD
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEBURG
Mailing Address - State:IN
Mailing Address - Zip Code:47025-1055
Mailing Address - Country:US
Mailing Address - Phone:812-537-1302
Mailing Address - Fax:
Practice Address - Street 1:285 BIELBY RD
Practice Address - Street 2:
Practice Address - City:LAWRENCEBURG
Practice Address - State:IN
Practice Address - Zip Code:47025-1055
Practice Address - Country:US
Practice Address - Phone:812-537-1302
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-03
Last Update Date:2008-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker