Provider Demographics
NPI:1063064095
Name:JOSEPH, KENYETTA MARIE (LCSW-C)
Entity type:Individual
Prefix:MRS
First Name:KENYETTA
Middle Name:MARIE
Last Name:JOSEPH
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:MS
Other - First Name:KENYETTA
Other - Middle Name:MARIE
Other - Last Name:TAYLOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:14915 BROSCHART RD STE 2300
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-3350
Mailing Address - Country:US
Mailing Address - Phone:301-838-4987
Mailing Address - Fax:301-251-4588
Practice Address - Street 1:14915 BROSCHART RD STE 2300
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-3350
Practice Address - Country:US
Practice Address - Phone:301-838-4987
Practice Address - Fax:301-251-4588
Is Sole Proprietor?:No
Enumeration Date:2019-07-10
Last Update Date:2019-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD143931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical