Justin David Kennard, L.C.S.W.

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

6801100540 Issued in MI

Practice address

111 E Kirby St
Detroit, MI 48202-4003

Phone

(347) 690-0774

NPI assigned

Mar 21, 2014

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1395360000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1547164800000",
    "number": "1689091258",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4751 COMMONWEALTH ST",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482082225",
            "telephone_number": "973-214-9110"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 E KIRBY ST",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482024003",
            "telephone_number": "347-690-0774"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1775 E 14 MILE RD.",
            "address_2": "AWARENESS COUNSELING SUITE",
            "address_purpose": "LOCATION",
            "city": "BIRMINGHAM",
            "state": "MI",
            "postal_code": "480097206",
            "country_code": "US",
            "telephone_number": "973-214-9110",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KENNARD",
        "first_name": "JUSTIN",
        "middle_name": "DAVID",
        "credential": "L.C.S.W.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2014-03-21",
        "last_updated": "2019-01-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MI",
            "license": "6801100540",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Diane Kendrick-Jeffery, RN
• Louis W Kendrick, P.T.
• Vertongie R Kendrix-Bailey
• Barbara Kendzierski
• Ryan Joseph Kenerson, MD
• Natalie Marie Kennaw, NP
• Kennedy Community Development Ministries
• Brian Kennedy
• Charlotte M Kennedy, LMSW
• Christopher James Kennedy, DPM

• Clinical Social Worker in Detroit, MI
• Providers in Detroit, MI by specialty
• Clinical Social Worker in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.