Provider Demographics
NPI:1366866048
Name:KENNEDY, MARTRICE (DOCSOCSCI,LCSW)
Entity type:Individual
Prefix:DR
First Name:MARTRICE
Middle Name:
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:DOCSOCSCI,LCSW
Other - Prefix:
Other - First Name:MARTRICE
Other - Middle Name:
Other - Last Name:GASKINS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DOCSOCSCI, LCSW
Mailing Address - Street 1:241 FILBERT AVE
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19805-2549
Mailing Address - Country:US
Mailing Address - Phone:215-678-9738
Mailing Address - Fax:
Practice Address - Street 1:1000 N WEST ST STE 1200
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19801-1058
Practice Address - Country:US
Practice Address - Phone:302-729-2398
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-14
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
DEQ1-00123381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health