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General NPI Number Information
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NPI Number | 1447091806
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Entity Type | Individual
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Provider Name | MARIE KENNEDY LMSW
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Gender | Female
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Dates
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Enumeration Date | 06/01/2024
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Last Update Date | 06/01/2024
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Provider Practice Location Address
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Address Line | 1325 QUINCY ST NE
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City | WASHINGTON
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State | DC
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Zip | 20017-2615
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Country | US
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Telephone | 202-813-0454
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Fax |
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Provider Business Mailing Address
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Address Line | 200 COMMANDER CV
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City | STAFFORD
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State | VA
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Zip | 22554-2402
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Country | US
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Telephone | 732-895-3422
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 0903003455
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License Number State | VA
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