Active NPI
Diana Lynne Kennedy, MSW,LCSW
- Clinical Social Worker
- Las Vegas, NV
National Provider Identifier
1417164401
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 5287-C
- Practice address
- 4760 S Pecos Rd
Suite 103 Unit 14
Las Vegas, NV 89121-6038 - Phone
- (702) 274-4116
- Fax
- (702) 434-6424
- NPI assigned
- May 17, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 5287-C | NV | Primary |
Addresses
Primary practice location
4760 S Pecos Rd
Suite 103 Unit 14
Las Vegas, NV 89121-6038
Mailing address
2777 Paradise Rd
Suite 1404
Las Vegas, NV 89109
Phone (702) 274-4116
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1179360000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1425600000000",
"number": "1417164401",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2777 PARADISE RD",
"address_2": "SUITE 1404",
"city": "LAS VEGAS",
"state": "NV",
"postal_code": "89109",
"telephone_number": "702-274-4116",
"fax_number": "702-434-6424"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4760 S PECOS RD",
"address_2": "SUITE 103 UNIT 14",
"city": "LAS VEGAS",
"state": "NV",
"postal_code": "891216038",
"telephone_number": "702-274-4116",
"fax_number": "702-434-6424"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KENNEDY",
"first_name": "DIANA",
"middle_name": "LYNNE",
"credential": "MSW,LCSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-05-17",
"last_updated": "2015-03-06",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "NV",
"license": "5287-C",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Las Vegas, NV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 6, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.