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NPI Code Detail

MEDICARE: MS. KELLY MARIE LENNON LCSW

MEDICARE: MS. KELLY MARIE LENNON 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
11041C0700XClinical Social WorkerLCS27164CA
21041C0700XClinical Social WorkerLICSW 113164MA

General Provider Information

NPI Number : 1659636587
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. KELLY MARIE LENNON LCSW
Provider Business Mailing Address
First Line : 1944 FILLMORE ST
Second Line :
City : SAN FRANCISCO
State : CA
Zip : 94115-2745
Country : US
Telephone Number : 415-944-3630
Fax Number :
Provider Business Practice Location Address
First Line : 1944 FILLMORE ST
Second Line :
City : SAN FRANCISCO
State : CA
Zip : 94115-2745
Country : US
Telephone Number : 415-944-3630
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/06/2012
Last Update Date : 08/22/2013

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