Healthcare Provider Details

I. General information

NPI: 1255868121
Provider Name (Legal Business Name): KATHLEEN MARIE KENNEDY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2017
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 EXECUTIVE PARK DRIVE SUITE 201
NEWTON MA
02462
US

IV. Provider business mailing address

89 ACCESS RD STE 24
NORWOOD MA
02062-5233
US

V. Phone/Fax

Practice location:
  • Phone: 781-551-0999
  • Fax:
Mailing address:
  • Phone: 781-551-0999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI1600080
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number62318
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number121405
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: