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General NPI Number Information
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NPI Number | 1093290306
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Entity Type | Individual
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Provider Name | SUSAN MARIE KENNEDY LCSW, CASAC2, FPA
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Gender | Female
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Dates
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Enumeration Date | 10/02/2018
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Last Update Date | 03/09/2023
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Provider Practice Location Address
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Address Line | 950 S OYSTER BAY RD
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City | HICKSVILLE
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State | NY
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Zip | 11801-3511
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Country | US
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Telephone | 631-822-6111
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Fax |
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Provider Business Mailing Address
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Address Line | 950 S OYSTER BAY RD
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City | HICKSVILLE
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State | NY
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Zip | 11801-3511
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Country | US
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Telephone | 516-396-2832
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 10816
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License Number State | NY
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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 | 094851
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number |
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License Number State | NY
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Taxonomy #4
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 048762
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License Number State | NY
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