Provider Demographics
NPI:1750401394
Name:SARGENT, KENNARI (MSW,LICSW)
Entity type:Individual
Prefix:
First Name:KENNARI
Middle Name:
Last Name:SARGENT
Suffix:
Gender:F
Credentials:MSW,LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6444 31ST ST NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20015-2342
Mailing Address - Country:US
Mailing Address - Phone:202-431-7078
Mailing Address - Fax:202-237-8554
Practice Address - Street 1:5247 WISCONSIN AVE NW
Practice Address - Street 2:SUITE 3, SECOND FLOOR
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20015-2012
Practice Address - Country:US
Practice Address - Phone:202-431-7078
Practice Address - Fax:202-237-8554
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC3023491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCJ1630001OtherCARE FIRST BCBS