Provider Demographics
NPI:1366061178
Name:KENNEDY, JULIETTE FAUST (LCSW)
Entity type:Individual
Prefix:MS
First Name:JULIETTE
Middle Name:FAUST
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:JULIETTE
Other - Middle Name:BARBARA
Other - Last Name:FAUST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:41 UNION SQUARE WEST
Mailing Address - Street 2:SUITE 735
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003
Mailing Address - Country:US
Mailing Address - Phone:917-922-4708
Mailing Address - Fax:
Practice Address - Street 1:585 MACDONOUGH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11233-1305
Practice Address - Country:US
Practice Address - Phone:917-459-8540
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-11
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY8423711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical