Provider Demographics
NPI:1740832047
Name:KENNEY, ALECIA (BS)
Entity type:Individual
Prefix:
First Name:ALECIA
Middle Name:
Last Name:KENNEY
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10529 BLYTHVILLE RD
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34608-2024
Mailing Address - Country:US
Mailing Address - Phone:352-263-5033
Mailing Address - Fax:
Practice Address - Street 1:10529 BLYTHVILLE RD
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34608-2024
Practice Address - Country:US
Practice Address - Phone:352-263-5033
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-16
Last Update Date:2019-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL900341538Medicaid