Provider Demographics
NPI:1588705511
Name:KENNEDY, BETH JOAN (MSW, LMSW)
Entity type:Individual
Prefix:MRS
First Name:BETH
Middle Name:JOAN
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:MSW, LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9241 S KESTREL RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:48116-5151
Mailing Address - Country:US
Mailing Address - Phone:586-306-9645
Mailing Address - Fax:
Practice Address - Street 1:4896 CHILSON RD
Practice Address - Street 2:
Practice Address - City:HOWELL
Practice Address - State:MI
Practice Address - Zip Code:48843-9453
Practice Address - Country:US
Practice Address - Phone:810-206-2086
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-11
Last Update Date:2023-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801084549104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker