Healthcare Provider Details

I. General information

NPI: 1831311513
Provider Name (Legal Business Name): MARY ANN KENNEDY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2131 HIGHWAY RT 33 LEXINGTON SQUARE COMMONS
HAMILTON NJ
08690
US

IV. Provider business mailing address

2131 HIGHWAY RT 33 LEXINGTON SQUARE COMMONS
HAMILTON NJ
08690
US

V. Phone/Fax

Practice location:
  • Phone: 609-585-4900
  • Fax: 609-585-4902
Mailing address:
  • Phone: 609-585-4900
  • Fax: 609-585-4902

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC04641400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: