Individual
KENISHA RENEE PEDEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
510 GRAND VALLEY BLVD, MARTINSVILLE, IN 46151-5883
(856) 239-3800
Mailing address
510 GRAND VALLEY BLVD, MARTINSVILLE, IN 46151-5883
(856) 239-3800
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
34009645A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0411150535
—
IN
Enumeration date
01/25/2023
Last updated
01/25/2023
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