Provider Demographics
NPI:1811094964
Name:KENNY, SHARON LEE (BSW, LMT)
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:LEE
Last Name:KENNY
Suffix:
Gender:F
Credentials:BSW, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1676
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34995-1676
Mailing Address - Country:US
Mailing Address - Phone:772-221-1080
Mailing Address - Fax:
Practice Address - Street 1:611 SW FEDERAL HWY
Practice Address - Street 2:SUITE C2B
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-2925
Practice Address - Country:US
Practice Address - Phone:772-221-1080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA 5360174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist