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General NPI Number Information
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NPI Number | 1487832127
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Entity Type | Individual
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Provider Name | SUSAN ELIZABETH KENYON MSW, LCSW
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Gender | Female
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Dates
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Enumeration Date | 02/05/2008
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Last Update Date | 02/17/2015
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Provider Practice Location Address
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Address Line | 1712 OSBORNE RD STE F
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City | SAINT MARYS
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State | GA
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Zip | 31558-9103
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Country | US
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Telephone | 912-510-9227
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Fax | 912-510-9228
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Provider Business Mailing Address
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Address Line | 1712 OSBORNE RD STE F
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City | SAINT MARYS
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State | GA
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Zip | 31558-9103
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Country | US
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Telephone | 912-510-9227
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Fax | 912-510-9228
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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 | CSW003827
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License Number State | GA
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