MEDICARE: DARCY BROOK KENNEDY LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	L2398	OR

General Provider Information

NPI Number	:	1205113032
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DARCY BROOK KENNEDY LCSW

Provider Business Mailing Address
First Line	:	14611 UPLANDS DR
Second Line	:
City	:	LAKE OSWEGO
State	:	OR
Zip	:	97034-2753
Country	:	US
Telephone Number	:	619-212-3595
Fax Number	:

Provider Business Practice Location Address
First Line	:	11211 SE 82ND AVE
Second Line	:	SUITE O
City	:	HAPPY VALLEY
State	:	OR
Zip	:	97086-7624
Country	:	US
Telephone Number	:	503-722-6200
Fax Number	:	503-722-6545

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/08/2011
Last Update Date	:	03/10/2026

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