Healthcare Provider Details

I. General information

NPI: 1881958338
Provider Name (Legal Business Name): ANGELA A KENEDY LIMHP, LCSW, LADC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2012
Last Update Date: 05/23/2026
Certification Date: 05/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4611 S 96TH ST STE 174
OMAHA NE
68127-1242
US

IV. Provider business mailing address

4611 S 96TH ST STE 174
OMAHA NE
68127-1242
US

V. Phone/Fax

Practice location:
  • Phone: 402-320-2336
  • Fax:
Mailing address:
  • Phone: 402-320-2336
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number1291
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1645
License Number StateNE
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2356
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: