MEDICARE: MR. MELVIN KENNY JR. LMSW

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	104100000X	Social Worker	114180-1	NY

General Provider Information

NPI Number	:	1740093558
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MELVIN KENNY JR. LMSW

Provider Business Mailing Address
First Line	:	24022 143RD AVE
Second Line	:
City	:	ROSEDALE
State	:	NY
Zip	:	11422-2010
Country	:	US
Telephone Number	:	347-752-3149
Fax Number	:

Provider Business Practice Location Address
First Line	:	24022 143RD AVE
Second Line	:
City	:	ROSEDALE
State	:	NY
Zip	:	11422-2010
Country	:	US
Telephone Number	:	347-752-3149
Fax Number	:

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

Provider Enumeration Date	:	01/28/2025
Last Update Date	:	01/28/2025

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