Healthcare Provider Details

I. General information

NPI: 1174584163
Provider Name (Legal Business Name): ANN M KENNEY LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2006
Last Update Date: 06/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1311 BEDFORD ST
FALL RIVER MA
02723-2637
US

IV. Provider business mailing address

333 UNION ST
NEW BEDFORD MA
02740
US

V. Phone/Fax

Practice location:
  • Phone: 508-567-1477
  • Fax: 508-567-6494
Mailing address:
  • Phone: 508-990-0852
  • Fax: 508-990-4777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1024761
License Number StateMA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierP07879
Identifier TypeOTHER
Identifier StateMA
Identifier IssuerBCBS
# 2
Identifier1851934
Identifier TypeMEDICAID
Identifier StateMA
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: