MEDICARE: MRS. AMY KENNEY 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	SW 12069	FL

General Provider Information

NPI Number	:	1912302902
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. AMY KENNEY LCSW

Provider Business Mailing Address
First Line	:	900 NE 18TH AVE
Second Line	:	1207
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33304-3063
Country	:	US
Telephone Number	:	855-241-7160
Fax Number	:	954-324-8354

Provider Business Practice Location Address
First Line	:	900 NE 18TH AVE
Second Line	:	1207
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33304-3063
Country	:	US
Telephone Number	:	855-241-7160
Fax Number	:	954-324-8354

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

Provider Enumeration Date	:	11/03/2014
Last Update Date	:	11/03/2014

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