MEDICARE: DEVAN KENNEDY LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	112239	TX

General Provider Information

NPI Number	:	1154160059
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEVAN KENNEDY LCSW

Provider Business Mailing Address
First Line	:	910 S CROWLEY RD STE 9
Second Line	:
City	:	CROWLEY
State	:	TX
Zip	:	76036-4360
Country	:	US
Telephone Number	:	682-268-0011
Fax Number	:

Provider Business Practice Location Address
First Line	:	3509 HULEN ST STE 100
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76107-6800
Country	:	US
Telephone Number	:	682-268-0011
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/21/2024
Last Update Date	:	03/13/2026

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Directions to “ DEVAN KENNEDY LCSW” Practice Location

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