MEDICARE: MS. SHERRILL KENNEDY LENNON 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	1041S0200X	School Social Worker	030271-1	NY

General Provider Information

NPI Number	:	1972872323
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SHERRILL KENNEDY LENNON LMSW

Provider Business Mailing Address
First Line	:	140 MIDDLE RD
Second Line	:
City	:	BLUE POINT
State	:	NY
Zip	:	11715-1908
Country	:	US
Telephone Number	:	631-730-4326
Fax Number	:

Provider Business Practice Location Address
First Line	:	50 DEAN LN
Second Line	:
City	:	STONY BROOK
State	:	NY
Zip	:	11790-2700
Country	:	US
Telephone Number	:	631-730-4326
Fax Number	:

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

Provider Enumeration Date	:	12/14/2011
Last Update Date	:	12/14/2011

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