MEDICARE: MRS. BETH JOAN KENNEDY MSW, LMSW

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	104100000X	Social Worker	6801084549	MI

General Provider Information

NPI Number	:	1588705511
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. BETH JOAN KENNEDY MSW, LMSW

Provider Business Mailing Address
First Line	:	9241 S KESTREL RIDGE RD
Second Line	:
City	:	BRIGHTON
State	:	MI
Zip	:	48116-5151
Country	:	US
Telephone Number	:	586-306-9645
Fax Number	:

Provider Business Practice Location Address
First Line	:	4896 CHILSON RD
Second Line	:
City	:	HOWELL
State	:	MI
Zip	:	48843-9453
Country	:	US
Telephone Number	:	810-206-2086
Fax Number	:

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

Provider Enumeration Date	:	02/11/2007
Last Update Date	:	12/17/2023

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