Provider Demographics
NPI:1215302302
Name:KENNEDY, KATIE (LCSW)
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2833 BRAKLEY DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-2695
Mailing Address - Country:US
Mailing Address - Phone:225-214-1617
Mailing Address - Fax:225-216-0082
Practice Address - Street 1:2833 BRAKLEY DR
Practice Address - Street 2:SUITE B
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70816-2695
Practice Address - Country:US
Practice Address - Phone:225-214-1617
Practice Address - Fax:225-216-0082
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-01
Last Update Date:2015-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA89931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical