Provider Demographics
NPI:1912151655
Name:KENNEDY, CAROLYN (MSW)
Entity Type:Individual
Prefix:MRS
First Name:CAROLYN
Middle Name:
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 US OVAL
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PLATTSBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12903-5900
Mailing Address - Country:US
Mailing Address - Phone:518-561-1767
Mailing Address - Fax:518-561-1795
Practice Address - Street 1:22 US OVAL
Practice Address - Street 2:SUITE 100
Practice Address - City:PLATTSBURGH
Practice Address - State:NY
Practice Address - Zip Code:12903-5900
Practice Address - Country:US
Practice Address - Phone:518-561-1767
Practice Address - Fax:518-561-1795
Is Sole Proprietor?:No
Enumeration Date:2008-11-07
Last Update Date:2009-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical