Individual
AMY KENNICUTT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
18 BROAD ST, JOHNSON CITY, NY 13790-2106
(607) 798-7117
Mailing address
18 BROAD ST, JOHNSON CITY, NY 13790-2106
(607) 798-7117
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
126674
NY
Other
Enumeration date
12/02/2024
Last updated
02/24/2025
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