Provider Demographics
NPI:1336379965
Name:KENNETT, GARY C (LICSW)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:C
Last Name:KENNETT
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:97 FOREST PARK AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01108-1631
Mailing Address - Country:US
Mailing Address - Phone:413-739-0882
Mailing Address - Fax:413-781-5729
Practice Address - Street 1:97 FOREST PARK AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01108
Practice Address - Country:US
Practice Address - Phone:413-654-7204
Practice Address - Fax:413-747-2655
Is Sole Proprietor?:No
Enumeration Date:2009-07-16
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1156871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical