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General NPI Number Information
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NPI Number | 1437446119
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Entity Type | Individual
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Provider Name | SHELLY L KENNEDY LCSW
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Gender | Female
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Dates
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Enumeration Date | 07/01/2011
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Last Update Date | 10/18/2023
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Provider Practice Location Address
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Address Line | 9 AUSTIN DR STE 201
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City | MARLBOROUGH
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State | CT
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Zip | 06447-1375
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Country | US
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Telephone | 860-300-6700
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 623
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City | HARWICH PORT
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State | MA
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Zip | 02646-0623
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Country | US
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Telephone | 860-300-6700
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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 | 007381
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License Number State | CT
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