MEDICARE: KENDALL JOHNSON-SMITH 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	1041C0700X	Clinical Social Worker	096785	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	096785	OTHER	NY	LICENSE NUMBER

General Provider Information

NPI Number	:	1770181190
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENDALL JOHNSON-SMITH LMSW

Provider Business Mailing Address
First Line	:	108 KENILWORTH PLACE
Second Line	:	COMM. 2
City	:	BROOKLYN
State	:	NY
Zip	:	11210-2439
Country	:	US
Telephone Number	:	347-627-8400
Fax Number	:

Provider Business Practice Location Address
First Line	:	108 KENILWORTH PLACE
Second Line	:	COMM. 2
City	:	BROOKLYN
State	:	NY
Zip	:	11210-2439
Country	:	US
Telephone Number	:	347-627-8400
Fax Number	:

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

Provider Enumeration Date	:	10/16/2020
Last Update Date	:	03/15/2026

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