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General NPI Number Information
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NPI Number | 1033126396
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Entity Type | Individual
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Provider Name | SHEILA GRACE KENNEDY LCSW
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Gender | Female
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Dates
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Enumeration Date | 08/01/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 3801 MIRANDA AVE
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City | PALO ALTO
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State | CA
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Zip | 94304-1207
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Country | US
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Telephone | 650-849-0176
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Fax |
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Provider Business Mailing Address
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Address Line | 67 LORELEI LN
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City | MENLO PARK
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State | CA
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Zip | 94025-1715
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Country | US
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Telephone | 650-321-4818
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 57852643501
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License Number State | UT
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 23533
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License Number State | CA
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