Healthcare Provider Details

I. General information

NPI: 1942818018
Provider Name (Legal Business Name): TRACY ELIZABETH KENNEDY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2020
Last Update Date: 10/08/2020
Certification Date: 10/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5664 SW 60TH AVE
OCALA FL
34474-5677
US

IV. Provider business mailing address

3 BAHIA PASS PL
OCALA FL
34472-8291
US

V. Phone/Fax

Practice location:
  • Phone: 352-291-5555
  • Fax: 352-291-5582
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number17226
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: