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4549 S Grant St Englewood CO 80113-5808 | |
| (772) 215-3657 | |
| (720) 386-9758 |
| Full Name | |
|---|---|
| Speciality | Social Worker |
| Location | 4549 S Grant St, Englewood, Colorado |
| Authorized Official Name and Position | Erica Kennedy (OWNER) |
| Authorized Official Contact | 7722153657 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
4549 S Grant St Englewood CO 80113-5808 Ph: (772) 215-3657 | 4549 S Grant St Englewood CO 80113-5808 Ph: (772) 215-3657 |
| NPI Number | 1629802137 |
|---|---|
| Provider Enumeration Date | 08/27/2024 |
| Last Update Date | 10/16/2024 |
| Certification Date | 10/16/2024 |
| Medicare PECOS PAC ID | 2961935903 |
|---|---|
| Medicare Enrollment ID | O20241029001860 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1629802137 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Erica L Kennedy |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1083114631 PECOS PAC ID: 3870857824 Enrollment ID: I20180430000239 |
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