Healthcare Provider Details

I. General information

NPI: 1285549048
Provider Name (Legal Business Name): MELISSA KENNER LCSW PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 CENTRE ST
FERNANDINA BEACH FL
32034-3936
US

IV. Provider business mailing address

6 MOSS OAKS DR
FERNANDINA BEACH FL
32034-5032
US

V. Phone/Fax

Practice location:
  • Phone: 904-601-5681
  • Fax:
Mailing address:
  • Phone: 904-601-5681
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MELISSA KENNER BRAND
Title or Position: LCSW
Credential: LCSW, LMSW
Phone: 904-583-7702