MEDICARE: MS. CAROL A KIENY LCSW, LISW-CP

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	44SC00838000	NJ
2	1041C0700X	Clinical Social Worker	10701	SC
3	1041C0700X	Clinical Social Worker	CW017565	PA
4	1041C0700X	Clinical Social Worker	59127	TX

General Provider Information

NPI Number	:	1316276504
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CAROL A KIENY LCSW, LISW-CP

Provider Business Mailing Address
First Line	:	1703 RICHLAND ST
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29201-2635
Country	:	US
Telephone Number	:	803-850-0022
Fax Number	:	844-517-6513

Provider Business Practice Location Address
First Line	:	1703 RICHLAND ST
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29201-2635
Country	:	US
Telephone Number	:	803-850-0022
Fax Number	:	844-517-6513

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

Provider Enumeration Date	:	12/16/2009
Last Update Date	:	06/18/2016

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