Provider Demographics
NPI:1730684002
Name:KENNEDY, SCOTT FREDERICK (LLMSW)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:FREDERICK
Last Name:KENNEDY
Suffix:
Gender:M
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34151 TAWAS TRL
Mailing Address - Street 2:
Mailing Address - City:WESTLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48185-2319
Mailing Address - Country:US
Mailing Address - Phone:734-604-9752
Mailing Address - Fax:
Practice Address - Street 1:34151 TAWAS TRL
Practice Address - Street 2:
Practice Address - City:WESTLAND
Practice Address - State:MI
Practice Address - Zip Code:48185-2319
Practice Address - Country:US
Practice Address - Phone:734-604-9752
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-28
Last Update Date:2022-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801102202104100000X
MI68011075251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker