Healthcare Provider Details

I. General information

NPI: 1770180069
Provider Name (Legal Business Name): KENNEDY SINGER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/08/2020
Last Update Date: 04/25/2024
Certification Date: 04/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2019 SATURN ST
MONTEREY PARK CA
91755-7415
US

IV. Provider business mailing address

5940 OAK AVE UNIT 163
TEMPLE CITY CA
91780-4406
US

V. Phone/Fax

Practice location:
  • Phone: 323-724-0019
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number120983
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: