Provider Demographics
NPI:1487241287
Name:KINDER, KENNY (LSW)
Entity type:Individual
Prefix:
First Name:KENNY
Middle Name:
Last Name:KINDER
Suffix:
Gender:M
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4122 W 57TH ST
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44144-1852
Mailing Address - Country:US
Mailing Address - Phone:440-834-2987
Mailing Address - Fax:
Practice Address - Street 1:4122 W 57TH ST
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44144-1852
Practice Address - Country:US
Practice Address - Phone:440-834-2987
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-28
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1041C0700X, 376J00000X
OH2005164104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No376J00000XNursing Service Related ProvidersHomemaker