MEDICARE: MRS. CAROLYN KENNEDY MSW

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

General Provider Information

NPI Number	:	1912151655
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CAROLYN KENNEDY MSW

Provider Business Mailing Address
First Line	:	22 US OVAL
Second Line	:	SUITE 100
City	:	PLATTSBURGH
State	:	NY
Zip	:	12903-5900
Country	:	US
Telephone Number	:	518-561-1767
Fax Number	:	518-561-1795

Provider Business Practice Location Address
First Line	:	22 US OVAL
Second Line	:	SUITE 100
City	:	PLATTSBURGH
State	:	NY
Zip	:	12903-5900
Country	:	US
Telephone Number	:	518-561-1767
Fax Number	:	518-561-1795

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

Provider Enumeration Date	:	11/07/2008
Last Update Date	:	07/22/2009

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