Provider Demographics
NPI:1194978411
Name:KENNEY, ANGELICA N (BS)
Entity type:Individual
Prefix:MRS
First Name:ANGELICA
Middle Name:N
Last Name:KENNEY
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:ANGELICA
Other - Middle Name:N
Other - Last Name:TAYLOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:585 LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01605-1906
Mailing Address - Country:US
Mailing Address - Phone:508-831-0045
Mailing Address - Fax:505-753-5051
Practice Address - Street 1:585 LINCOLN ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01605-1906
Practice Address - Country:US
Practice Address - Phone:508-831-0045
Practice Address - Fax:505-753-5051
Is Sole Proprietor?:No
Enumeration Date:2008-10-30
Last Update Date:2009-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1308785Medicaid
MA1306421Medicaid