Healthcare Provider Details

I. General information

NPI: 1477646255
Provider Name (Legal Business Name): LISA M KENNEY LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 11/11/2025
Certification Date: 11/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 CAMBRIDGE ST # 14
BOSTON MA
02114-2509
US

IV. Provider business mailing address

48 PAUL FRANCIS WAY
PLYMOUTH MA
02360-2710
US

V. Phone/Fax

Practice location:
  • Phone: 646-941-7645
  • Fax: 929-596-7897
Mailing address:
  • Phone: 617-710-6147
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number110813
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: