Provider Demographics
NPI:1740093558
Name:KENNY, MELVIN JR (LMSW)
Entity type:Individual
Prefix:MR
First Name:MELVIN
Middle Name:
Last Name:KENNY
Suffix:JR
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24022 143RD AVE
Mailing Address - Street 2:
Mailing Address - City:ROSEDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11422-2010
Mailing Address - Country:US
Mailing Address - Phone:347-752-3149
Mailing Address - Fax:
Practice Address - Street 1:24022 143RD AVE
Practice Address - Street 2:
Practice Address - City:ROSEDALE
Practice Address - State:NY
Practice Address - Zip Code:11422-2010
Practice Address - Country:US
Practice Address - Phone:347-752-3149
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-28
Last Update Date:2025-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY114180-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker