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General NPI Number Information
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NPI Number | 1215217179
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Entity Type | Individual
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Provider Name | SAMANTHA JEAN KENNEY LCSW-C
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Gender | Female
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Dates
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Enumeration Date | 08/24/2011
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Last Update Date | 09/14/2015
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Provider Practice Location Address
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Address Line | 11120 SOMERSET AVE
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City | PRINCESS ANNE
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State | MD
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Zip | 21853-2970
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Country | US
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Telephone | 410-651-4200
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Fax |
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Provider Business Mailing Address
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Address Line | 2336 GODDARD PKWY
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City | SALISBURY
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State | MD
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Zip | 21801-1126
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Country | US
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Telephone | 410-334-6961
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Fax | 410-334-6362
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 17350
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License Number State | MD
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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 | 17350
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License Number State | MD
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