Provider Demographics
NPI:1568731099
Name:KENNEDY, MARIA K (LCSW)
Entity type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:K
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 1:15 MDG
Mailing Address - Street 2:755 SCOTT CIRCLE
Mailing Address - City:JBPHH
Mailing Address - State:HI
Mailing Address - Zip Code:96853
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:15 MDG
Practice Address - Street 2:755 SCOTT CIRCLE
Practice Address - City:JBPHH
Practice Address - State:HI
Practice Address - Zip Code:96853
Practice Address - Country:US
Practice Address - Phone:808-448-6240
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-29
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKCSWS13241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical