Provider Demographics
NPI:1285701201
Name:KENNEY, PATRICIA LEE (LCSW MAC SAP)
Entity type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:LEE
Last Name:KENNEY
Suffix:
Gender:F
Credentials:LCSW MAC SAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:717 E ELMER ST
Mailing Address - Street 2:STE 6
Mailing Address - City:VINELAND
Mailing Address - State:NJ
Mailing Address - Zip Code:08360-4758
Mailing Address - Country:US
Mailing Address - Phone:856-691-2424
Mailing Address - Fax:856-691-2433
Practice Address - Street 1:717 E ELMER ST
Practice Address - Street 2:STE 6
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08360-4758
Practice Address - Country:US
Practice Address - Phone:856-691-2424
Practice Address - Fax:856-691-2433
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22021101YA0400X
NJ12286101YA0400X
NJ44SC047646001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ232130OtherAMERI HEALTH PPO PIN 4000
NJ046194Medicare ID - Type Unspecified