MEDICARE: KENNAH LEA DUONG 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	0904019612	VA

General Provider Information

NPI Number	:	1205791357
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENNAH LEA DUONG LCSW

Provider Business Mailing Address
First Line	:	1005 SOPHIA ST STE 200
Second Line	:
City	:	FREDERICKSBURG
State	:	VA
Zip	:	22401-3809
Country	:	US
Telephone Number	:	540-907-0991
Fax Number	:

Provider Business Practice Location Address
First Line	:	1005 SOPHIA ST STE 200
Second Line	:
City	:	FREDERICKSBURG
State	:	VA
Zip	:	22401-3809
Country	:	US
Telephone Number	:	540-907-0991
Fax Number	:

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

Provider Enumeration Date	:	12/22/2025
Last Update Date	:	12/22/2025

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