Healthcare Provider Details

I. General information

NPI: 1760032023
Provider Name (Legal Business Name): MARY JULIANNE KENNY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/18/2019
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 RAILROAD ST
NORTH TROY VT
05859-9790
US

IV. Provider business mailing address

4 RAILROAD ST
NORTH TROY VT
05859-9790
US

V. Phone/Fax

Practice location:
  • Phone: 860-389-1027
  • Fax:
Mailing address:
  • Phone: 860-389-1027
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number010687
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number089.0136894
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: