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General NPI Number Information
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NPI Number | 1891576690
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Entity Type | Organization
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Legal Business Name | ELIZABETH KENNEDY A LICENSED CLINICAL SOCIAL WORKER, A PROFESSIONAL CO
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Dates
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Enumeration Date | 10/09/2023
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Last Update Date | 10/09/2023
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Provider Practice Location Address
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Address Line | 1505 SHEPARD DR STE 204
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City | SANTA MARIA
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State | CA
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Zip | 93454-7016
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Country | US
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Telephone | 805-765-2300
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Fax | 805-944-1543
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Provider Business Mailing Address
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Address Line | PO BOX 7842
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City | SANTA MARIA
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State | CA
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Zip | 93456-7842
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Country | US
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Telephone | 805-878-1863
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Fax | 805-944-1543
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Authorized Official
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Title or Position | CEO
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Name | VIRGILIA ELIZABETH KENNEDY
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Credential | LCSW
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Telephone | 805-878-1863
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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