Provider Demographics
NPI:1588689384
Name:KENT, JOSHUA M (LICSW MSW)
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:M
Last Name:KENT
Suffix:
Gender:M
Credentials:LICSW MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9007 KAGAN AVE NE
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:MN
Mailing Address - Zip Code:55362
Mailing Address - Country:US
Mailing Address - Phone:612-710-3671
Mailing Address - Fax:763-295-4946
Practice Address - Street 1:7616 CURRELL BLVD
Practice Address - Street 2:SUITE 275
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125
Practice Address - Country:US
Practice Address - Phone:612-710-3671
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN15118104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker