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General NPI Number Information
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NPI Number | 1316455686
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Entity Type | Organization
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Legal Business Name | BRANDY KENWORTHY AND ASSOCIATES LTD
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Dates
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Enumeration Date | 01/19/2018
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Last Update Date | 01/19/2018
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Provider Practice Location Address
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Address Line | 1821 WALDEN OFFICE SQ STE 427
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City | SCHAUMBURG
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State | IL
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Zip | 60173-4295
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Country | US
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Telephone | 773-458-6904
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Fax |
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Provider Business Mailing Address
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Address Line | 3201 CALIFORNIA AVE
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City | ROLLING MEADOWS
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State | IL
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Zip | 60008-2226
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Country | US
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Telephone | 773-458-6904
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Fax |
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Authorized Official
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Title or Position | OWNER/PSYCHOTHERAPIST
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Name | BRANDY KENWORTHY
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Credential | MSW, LCSW
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Telephone | 773-458-6904
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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 | 149011992
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License Number State | IL
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