Individual
CHARLES A KENNEDY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
4120 N 20TH ST STE B, PHOENIX, AZ 85016-6022
(602) 284-9343
(602) 651-1043
Mailing address
3104 E CAMELBACK RD # 721, PHOENIX, AZ 85016-4502
(602) 284-9343
(602) 651-1043
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
6962-123
WI
1041C0700X
Clinical Social Worker
Primary
LCSW-12461
AZ
Other
Enumeration date
10/25/2006
Last updated
08/11/2010
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