Provider Demographics
NPI:1902061179
Name:KENNEDY, KAREN MARGARET (MSW)
Entity Type:Individual
Prefix:MS
First Name:KAREN
Middle Name:MARGARET
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46143-1364
Mailing Address - Country:US
Mailing Address - Phone:317-807-0456
Mailing Address - Fax:866-788-3791
Practice Address - Street 1:420 E MAIN ST
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46143-1364
Practice Address - Country:US
Practice Address - Phone:317-807-0456
Practice Address - Fax:866-788-3791
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-27
Last Update Date:2008-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34005582A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health