MEDICARE: KENNY'S CREW ABA LLC

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	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1821947169
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KENNY'S CREW ABA LLC

Provider Business Mailing Address
First Line	:	440 MONTICELLO AVE STE 1802
Second Line	:
City	:	NORFOLK
State	:	VA
Zip	:	23510-2670
Country	:	US
Telephone Number	:	205-401-9123
Fax Number	:

Provider Business Practice Location Address
First Line	:	440 MONTICELLO AVE STE 1802
Second Line	:
City	:	NORFOLK
State	:	VA
Zip	:	23510-2670
Country	:	US
Telephone Number	:	205-401-9123
Fax Number	:

Authorized Official
Title or Position	:	BEHAVIOR ANALYST
Name	:	TAMERIA EDWARDS-BREWER
Credential	:	BCBA
Telephone Number	:	205-401-9123

Provider Enumeration Date	:	01/28/2026
Last Update Date	:	01/28/2026

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