MEDICARE: MS. MARY L. 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	072954-1	NY
2	1041C0700X	Clinical Social Worker	LCS20425	CA

General Provider Information

NPI Number	:	1740332709
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARY L. KENNEDY LCSW

Provider Business Mailing Address
First Line	:	3702 SACRAMENTO ST # D
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94118-1740
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3702 SACRAMENTO ST # D
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94118-1740
Country	:	US
Telephone Number	:	415-689-1690
Fax Number	:

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

Provider Enumeration Date	:	01/18/2007
Last Update Date	:	04/04/2022

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