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NPI Code Detail

MEDICARE: DR. MARTRICE KENNEDY DOCSOCSCI,LCSW

MEDICARE: DR. MARTRICE KENNEDY DOCSOCSCI,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
1101YM0800XMental Health Counselor
21041C0700XClinical Social WorkerQ1-0012338DE

General Provider Information

NPI Number : 1366866048
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MARTRICE KENNEDY DOCSOCSCI,LCSW
Provider Business Mailing Address
First Line : 241 FILBERT AVE
Second Line :
City : WILMINGTON
State : DE
Zip : 19805-2549
Country : US
Telephone Number : 215-678-9738
Fax Number :
Provider Business Practice Location Address
First Line : 1000 N WEST ST STE 1200
Second Line :
City : WILMINGTON
State : DE
Zip : 19801-1058
Country : US
Telephone Number : 302-729-2398
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/14/2014
Last Update Date : 10/30/2024

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