MEDICARE: TERESA ANNE 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	Q1-0001533	DE

General Provider Information

NPI Number	:	1558444240
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERESA ANNE KENNEDY LCSW

Provider Business Mailing Address
First Line	:	4735 OGLETOWN STANTON RD STE 1201
Second Line	:
City	:	NEWARK
State	:	DE
Zip	:	19713-2089
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4735 OGLETOWN STANTON RD STE 1201
Second Line	:
City	:	NEWARK
State	:	DE
Zip	:	19713-2089
Country	:	US
Telephone Number	:	302-623-4330
Fax Number	:

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

Provider Enumeration Date	:	10/24/2006
Last Update Date	:	04/01/2019

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